Scared, with several questions...

[JoeinMO]

I am a 26 year old male, in reasonably good health. I have high blood pressure (I take Toprol for), as well as chronic gout. I take Alleve and Colchicine when I have flare-ups of gout.

Recently, I began have difficulty urinating. Some days I couldn't go at all, other days I couldn't stop going. At first I believed it to be Prostatitis, which I've had once before. After a couple weeks of antibiotic treatment (Cipro and Zithromax), I went back to the doctor because I had no relief. My urine had become "bubbly" or "foamy." My doctor did a urinalysis and informed me that my Protein in my urine was "4." He didn't seem very concerned, but told me to come back for another urine test in a week. (This coming Tuesday.) He suggested "kidney inflammation." I suffer from panic disorder and OCD, so I of course got on the internet and convinced myself that I have cancer. My wife is a Registered Nurse and works as the circulating nurse at a local hospital. She asked several urologists about these results, and again, none seemed overly concerned. One suggested that the problem was "medical renal failure" and suggested that I see a Nephrologist. (Whom I have an appointment with on Nov. 30.) He also said that cancer was so unlikely that it shouldn't even be on our minds.

I occasionally have very mild discomfort in my right "flank," but no serious pain. There is no blood in my urine, and I don't seem to have any other symptoms. (I'm slightly fatigued, but I suspect that it's more from the panic disorder/anxiety than anything else--I wasn't that tired until I came back from the doctor.)

Is it likely that I have cancer or some other fatal disease? If it's kidney disease, is it fatal or is there a cure/treatment that will enable me to lead a normal life?

I appreciate any responses.

[DoriSchatell]

Hi Joe,

Kidneys filter out wastes and excess fluid from the blood. Protein and other large molecules, like red blood cells, are normally too big to fit through the filters, so they are kept in the body. Having foamy or bubbly urine (plus a finding of protein in the urine) means the filtering units in your kidneys are "leaky"--they are letting through larger molecules than they should. So, one question is "why?", and another is, "how can this be stopped?" (Protein in the urine is not one of the symptoms of kidney cancer. Kidney cancer symptoms include blood in the urine, fatigue, weight loss, low back pain, a mass or lump in the abdomen, unexplained fever, and swelling in the ankles or feet).

Getting another protein test in a week is a good idea. Here is a link to an excellent U.S. government site with a lot of information about proteinuria (protein in the urine): http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/. As you'll see from reading it, sometimes this condition is temporary. If your protein is still high when your urine is retested, your doctor will talk with you about finding out why and deciding on treatment options.

Whether or not your second protein level is high, controlling your blood pressure is very important. High blood pressure damages the delicate filtering units (nephrons) inside the kidneys--kind of like a tire blowout. High blood pressure is the second leading cause of kidney failure. Besides medication, diet (the DASH diet--http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/), exercise, and reducing stress (consider meditation, for example) can also help bring your blood pressure down.

You didn't mention which blood pressure drugs you are taking. A class of blood pressure drugs called "ACE inhibitors" (e.g., ramipril, captopril) and another class called angiotensin receptor blockers (ARBs) have been helpful in reducing kidney damage in people who have proteinuria.

If it's kidney disease, is it fatal or is there a cure/treatment that will enable me to lead a normal life? Life is fatal! (No-one gets out of here alive). I spent today at the Seattle Kidney Expo, with a number of folks who have lived for decades with kidney failure, on a combination of dialysis and transplants. People with kidney failure can and do live normal lives, including working, traveling, pursuing hobbies, raising families, etc.

When you see your doctor again on Tuesday, ask what your serum creatinine level is (or if they haven't drawn a blood sample for creatinine, ask for this test). With this information, you can find out your glomerular filtration rate (GFR), which is the % kidney function you have. (Just look on-line for "GFR calculator" and plug in your numbers). If you have any loss of function, the GFR will allow us or your doctor to tell you what "stage" your kidney disease is and what sorts of things you should be thinking about.

Good luck, and try not to worry too much in the meantime.

[JoeinMO]

I appreciate your response!

My wife (the RN) assures me that even if it's kidney failure, I would still be able to lead a "normal" life. (As you said.)


Because of panic disorder, it's very, VERY difficult for me to believe that.

I've had blood tests done within the last 10-12 months checking kidney function (because of gout), but none have shown any abnormal results. (These were done before the foamy urine and urinalysis.)

How fast can kidney disease spring up? Wouldn't someone have noticed something before now?

[DoriSchatell]

Hi Joe,

Oops, sorry about missing your reference to Toprol--it's a beta blocker, though, not an ACE-inhibitor or an ARB.

How fast can kidney disease spring up? Wouldn't someone have noticed something before now

Chronic kidney disease is usually a slow, gradual process that takes years. Acute kidney disease is sudden, and can occur when an injury or disease attacks the kidneys. We're not doctors, and you don't have your lab test results back yet, but it's possible that you had some type of temporary damage. Or, chronic disease does have to start somewhere, and perhaps you caught it early.

With all of the previous tests you had, was a creatinine level drawn at your last visit?

[JoeinMO]

No, there was no creatnine tests done.



For the 2 and half previous weeks (to the urine getting foamy), I was on antibiotics. I took Cipro 500mg a day, and then Zithromax (the one dose pack), as well as Doxycycline.


Is it possible that those caused some sort of damage?


I know we're all just speculating at this point, but you know far more than I do...

[JoeinMO]

I just found this link http://www.fpnotebook.com/REN37.htm

that says that the mortality rate for acute renal failure is 64%! Is this true?

[DoriSchatell]

Hi Joe,

Cipro can cause kidney damage (usually in less than 1% of people who take it)--any damage is usually accompanied by a rash or fever (which you didn't mention having).

Zithromax can raise creatinine levels. I'm traveling home today and have to run, so I didn't get a chance to look up doxycycline, but I usually start with http://www.rxlist.com, so perhaps you and your wife could look there.

You'll want to mention these drugs when you go back to the doctor, so he or she has the full picture. And do ask for a creatinine level. :)

[JoeinMO]

That site said that doxycycline can cause elevated BUN numbers.


I guess my bottom line question is if this is caused by medicine/infection, how likely is it to kill me, or can it be reversed somehow...

[DoriSchatell]

Hi Joe,

As I said, I'm not a doctor, but the statistic you read about acute kidney failure is probably correct. It's important, though, to keep in mind that most acute kidney failure is probably in the context of multisystem organ failure--folks who have this are in the ICU, with kidney failure, liver failure, respiratory failure.

I believe you're walking around at home, am I right? So whatever level of kidney problem you may have, you are not critically ill, or even in kidney failure at this point (acute or chronic). And you are not in any immediate danger of dying.

So, as difficult as it is to wait until you get more test results, it does not seem that you are in any imminent danger. I hope this can ease your mind a bit.

As far as whether it is treatable, often when the kidneys suffer a acute damage due to a medication or illness, they can recover when the cause is removed. So, for example, since you have stopped taking these medications, they may aready be starting to heal. You'll know a lot more after the second wave of tests. Is your urine still foamy?

[Beth Witten MSW ACSW]

Dear JoeinMO:

I'd strongly suggest that you see a nephrologist as soon as possible. This is the specialist that knows the most and should be the most up-to-date about guidelines and treatments for kidney-related conditions. If your schedule is flexible, you might tell the nephrologist's office that you'd be able to come the same day if someone cancels an appointment.

In this article, it says that "as many as 90% of cases are estimated to have a potentially reversible cause." It also has a list of tests at the end that your doctor may want to do to evaluate your kidney function.
http://www.emedicine.com/EMERG/topic500.htm

I'd suggest that you take all your medicine bottles or make a list of all the drugs that you are taking with the dosages and frequencies to the doctor you're seeing now and to the nephrologist. Medications may affect lab values and sometimes other medications can be substituted to control the condition that won't cause the same side effects. Meanwhile, if you're taking medication for panic attacks and OCD, you might ask your doctor if that medicine is the best one to take in case you do have kidney problems.

[JoeinMO]

I just came back from the doctors office (I went early) and he said that I was mistaken the other day--my protein was a "1," and today it's "Trace."


I told him about seeing a Nephrologist, and he suggested that I should, just so I can hear the same thing from a specialist. He said that after that, I will be assured that I don't have anything like that. (Although he didn't even bring up seeing a Nephrologist.)


On 8-1-05, my creatinine was perfectly normal, as were all of the other kidney functions, except my Uric Acid, with was over 10. He said that the uric acid is likely the culprit this time, too, and it's not anything more sinister than that.

Does that mesh with what you guys know?

[Beth Witten MSW ACSW]

Normal kidneys leak no protein or only a trace (<20 mg/dl). What your doctor told you is good news. Here's something about measuring urine protein from the Family Practice Notebook:
www.fpnotebook.com/URO68.htm

The symptom that made me concerned when I read your first message was that you went for a day without urinating. You said that your symptoms hadn't changed with antibiotics. Did you tell your doctor this? Are you able to urinate normally now? Did your doctor feel your prostate to see if it was enlarged? An enlarged prostate can slow or stop the flow of urine. When urine can't get out of the body, it backs up in the urinary tract and can cause an infection in the bladder or kidneys. Here is a website that discusses the signs, symptoms, causes, labs, and treatments for benign prostatic hyperplasia:
www.fpnotebook.com/URO107.htm

If your kidney labs were normal, that's good. Be aware that high blood pressure can damage kidneys. Keeping your blood pressure under control is one way to protect your kidneys. You should ask your doctor to check your kidney labs (creatinine and BUN) regularly and I'd suggest asking your doctor for a copy of your lab report so you can see what your labs do over time.

Since your uric acid was high, you might want to look over this list of high purine foods and limit your intake of them as well as two other contributors to high uric acid levels -- alcohol and especially beer.
www.fpnotebook.com/PHA81.htm

[JoeinMO]

I never touch alcohol, even if I wasn't so afraid of gout!


My urinating is back to normal now--when I feel like I need to go, I can go with no problems, and I don't feel like I have to go every few minutes. (I feel relieved when I do go.) He did do a prostate exam and said that it felt fine, but suggested that I still see the Urologist, just so they can do a more thorough exam looking for infection there.


It's still foamy, but the test did show that it was only a "trace" amount, and he showed me the results from last week that showed a "1" not a "4" like I believed. Is there anything else that could be causing the urine to be foamy?

[JoeinMO]

My urine is still quite foamy, and the discomfort in my side is still there. If there's pressure applied to my right side (directly under my ribs), there's a decent amount of pain.


Like I said, on August 1st of this year, my kidneys were functioning just fine--is it possible/likely that this is a kidney infection?

With only "trace" amounts of protein in my urine and no blood, how likely is it that it's kidney disease/cancer?

[DoriSchatell]

Hi Joe,

Kidney cancer is unusual in people under age 40 (and often, people who get it are over 55). So, at age 26, it's not very likely that this is your problem--infection is much more likely. I assume your doctor's office did a urinalysis. Did they find any bacteria or pus?

[JoeinMO]

No, he found no bacteria or pus--nothing abnormal at all.


I also read that frequent hiccups are a symptom--and over the last week I've had the hiccups more than I had in the previous 25 years.

[DoriSchatell]

Hi Joe,

I did a search of the published medical literature using the terms "hiccups" and "cancer" and not a single one of the 56 articles had to do with kidney cancer. So, I'm not sure where you read that, but it's not in the scientific papers.

Since you still have concerns and some symptoms, and your regular doctor hasn't allayed your fears, I suggest that you ask for a referral to a nephrologist (kidney specialist), who can perhaps do more tests or better ease your mind about what's going on. The chances of it being cancer are extremely remote, but you need to know what it is so you know what it isn't.