[Allerian]

Has anyone had nephritis without having protein in their urine? My last several urine tests have had lot's of white cells, the last few white cells and red cells but no protein. The red cells it says 3-4 per high power field and for white 20-49. I know that's alot but I don't have a UTI. Nitrates aren't positive. And this has been over several months. My lupus has not been doing well this year from the stress of medical school. I was hoping that the blood I had was from my period (even though I had a new tampon) so we did a repeat a full week after my bleeding had stopped and that still had the 3-4 red cells. I've done some research (it's so dangerous being a med student) and people can have lupus nephritis with just red or white cells and have no protein. It looks like they are usually WHO stage 1-3. But still Nephritis. My nephrologist is going to recheck me before my next visit in december, but I'll see my rheumie in october and wonder if something should be done if this is going on? My creatinine has risen slightly from 0.7-0.9 this year. And BUN is still normal as is my blood pressure. So any lupies with nephritis without urine protein out there?

 

[cmfinnis]

Hi,

I read your post and thought, I must reply as I have the same dilemna as you! I'm 30 and since I was diagnosed 4 years ago I have had blood and WBCs in my urine tests (and occassionally slightly above normal protein). My blood pressure is ok and I have no symptoms of kidney disease. my renal function has gone down but is still ok - I think stage 2.

I have never had a biopsy so I don't know if I have nephritis or not . . . . my nephrologist wants to do an EDTA-GFR and then a biopsy if the GFR (glomerular filtration rate) has dropped.

Up until a year ago I was on mycophenaolate mofetil and that treated my lupus (and apparently treats nephritis really well too - same strength as cyctoxan) but the last year I've been on Aza.

let me know what you find out - I've found those articles/papers on google too, about nephritis without active sediment, but according to my nephrologist that is rare . ... .

take care

Cathy x

 

[Allerian]

I'm not sure that it's really rare. The studies that I've read took lupus patients with active symptoms like fatigue, rash and joint pain and categorized those that didn't have protein in urine into those that had WBCs and those that had RBCs. Then they biopisied those two groups of patients. For the WBC group 77% had abnormal biopsies with most being stage I or II. For the RBC group it was similarly high. So I don't think it's rare because most are stage I-III where you may not get protein spilling.

 

[Lily]

Hi Allerian,

I've just had an ultrasound of kidneys to check for lesions because of my history of red cells and some protein (only trace protein the last few months though which is good). No lesions were found so I think they are taking a wait and see approach, I will know more in a couple of months. I did get some peace of mind knowing they could see no sclerosing or lesions on the scan, of course biopsy is the only real sure fire way to know about these things but I don't think my clinical presentation warrants it at present.

hope this helps,

love
Lily

 

[cmfinnis]

Hi allerian

Interesting study! I don't think my nephrologist is aware of it . . . . . . and I attend St Thomas' too . . . . I did once see a renal team at Guys' hopsital in london tho and they diagnosed 'lupus nephrits, needs yearly GFRs and do urine dips at home, if anything changes, biopsy'. I have never seen these guys again . . .so . ....

Has anyone looked for casts? These are highly significant for nephritis. I have never had any proven renal casts and so again to quote my nephrologist she says that I may have 'subclinical' renal involvemnet. Grrrrrr, I like you have been worried for ages and keep asking! She did last time finally confess that yes, I very probably have nephritis but she's not keen on a biopsy till now as I am also on warfarin . . .go figure . ... (obviously you would stop the warfarin . . .)

Good Luck, let me know how you get on, I see my Nephrologist in about a month and I will let you know what she says THIS time .. .

Cathy x

 

[Allerian]

I saw my general practitioner yesterday for my annual visit and told her what has been going on and that I'm alittle anxious about. She suggested I see nephrology here in Milwaukee and they took another urine sample yesterday too. So I'm scheduled to see nephrology on Sept 8th. They want me to do a 24 hour urine and the lady on the phone didn't seem to know much about it and suggest I use a milk jug. I worked in a lab for a year and know they usually give out special containers with a hat for females. Hopefully that is the case here. I think I'll call next week to find out more about the 24 hour because I know there are only two sundays before the visit which would be the easiest time for me to do them. I've had two urine micros done and would assume they would look for casts and didn't see any. But I could be wrong. I think I am leaking some protein sometimes because sometimes my urine will be bubbly and other times not at all.

 

[SoCalEric]

On that 24hr, don't use a milk jug! They should supply ya with a jug, and ya may want two, I tend to fill one up! Being a guy I got it a bit easier in filling the things. Kinda funny when they hand me the funnel....uh, I will not be needing one of those! Sundays are good for the peeing (that's when I do it), then you'll need to drop it off and get blood drawn.
I've had a couple bouts of Nephritis, both with plenty of blood and protien in my urine, so can't really offer much on your troubles.

Best Wishes!,
Eric