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Have IgA Nephropathy, Hematuria, Edema In Legs And Less Kidney Function. Any Solution?
Question: My name is XXXXXXX I have a bit of a complicated case history. I will try to explain it as simply as possible and then send all necessary reports so that you can examine them. I joined the Canadian Militay in XXXXXXX 1992. I left the service in May 2009. One of the reasons for my leaving was due to my diagnosis of IgA Nephropathy. Since I was diagnosed I have received the best care that anyone could ask for from the best physicians and specialists. What I would like to find out is, after I present my medical documents to you, could my case have been identified sooner. Right now each of my kidney is functioning at 67%. Here is my case histroy:
I reported to the Academy medical clinic with pain on urination. Blood test was administered. No protinuria or hematuria reported in the urinalysis dated 7 Mar 1995. When repeated on 8 Mar 1995 small hematuria and no protineuria reported. No follow test performed. A blood and urine test that I had on 12 XXXXXXX 1996 showed trace amounts of blood and protien in my urine. No follow up tests were performed. I had a blood and urine test complete on 5 Dec 1997, total protien was reported as high. Tests conducted on 6 Dec 1997 showed large blood but negative for protien. Follow up blood work on 7 Dec 1997 showed hematocrit low, lymph% high; mxd high%; neut% high; lymphocytes high; INR high. Urine test on 8 Dec 1997 showed no protineuria or hematuria. Follow up urine test on 9 Dec 1997 again was negative for blood and protien. Final follow up blood work on 10 Dec 1997 had lymph% high; mxd% high; neut% low; and PT/INR high. On 16 Feb 1998 I had blood work done again which shoed low NA; CL and CO2. At this time I was also reporting to my Doctor that I had been having some real issues with leg swelling. So he gave me some stockings that I could wear at night to try and reduce the swelling (edema). He also recommended that I elevate them when I could to tey and decrease the swelling. I had more blood work done on 26 April 2000 which showed everything normal. I continued to suffer from edema in both legs. On January 22, 2001 I had bloodwork done which included creatnine, BUN; Albumin, all normal, nor urinalysis done or any other testing. I also had an appointment with an internist who completed a basic examination and determined the following: "no history of rheumatic fever or cardiac disease, she is not SAD, as for her DVT, she is no longer on birth control pills. She has not had a sedentry life style and does not have a histroy of liver or kidney disease. Physically she is a tall, 5 foot ten inch obese woman, blood pressure of 105/65, with normal first and second heart sounds. Her chest was clear, abdomen was soft. Ankle had a mild edema of about one plus. Pedal pulses were palpable. I think she has so called idiopathic cyclical edema XXXXXXX After this consult I received a second pair of elastic stockings.
My edema in my lower legs did not get better with a second pair of stockings, it only worsened. I continued to let my Doctors know, but nothing was done. I had a series of bloodwork and urine analyses completed in 2002: 17 Jul 2002 urinalysis showed trace blood. Bloodwork on 23 Jul 2002 showed low Hematocrit, urinalysis was negative for protien and blood. Urinalysis for 24 and 25 of Jul 2002 were also negative for blood and protien.
August of 2002 I applied to a life insurance company for life insurance and RRSPs. I had to complete bloodwork and urine sample as part of the apllication. Bloodwork was good but urine came back with blood in sample. I was denied for application and told that once I checked it out (I was told that it was probably an infection) that I would be able to re-apply. I waited a year (late summer 2003) and made application again only to find blood in the urine once more. (I did not tell them that I had not gone to see my Doctor about this possible urine infection the last time.)
I did not go to my Doctor this time because I was working shift work and I could not really find the time.
At this point when I went in to get a full work up done, the follow ups continued regularly and I was able to finally get a diagnosis. My edema was taken seriously and I was able to get answers.
I was transfered from the Halifax, NS area in October 2004 to XXXXXXX ON. At that time I went to establish a regular Doctor at the base I was going to be working at and requested a full blood work up and urinalysis. The results of the tests done 28 October 2004 showed trace protien and trace blood. The test was repeated 13 January 2005 and again there was trace protien and trace blood. I was then referred to an internest in Toronto and I was sent to a Neprologist in XXXXXXX by April 2006 and a biopsy completed, diagnosis confirmed as IgA Nephropathy.
From the point that I arrived in the XXXXXXX area, I was able to get things moving in the right direction. What I would like to know is could my kidney disease have been picked up earlier with better follow-ups and other testing?? If it could have been picked up earlier, how much earlier?? Thank you I look forward to your response. Please let me know which documents you would like to see and I will send them on to you. XXXXXXX XXXXXXX
I reported to the Academy medical clinic with pain on urination. Blood test was administered. No protinuria or hematuria reported in the urinalysis dated 7 Mar 1995. When repeated on 8 Mar 1995 small hematuria and no protineuria reported. No follow test performed. A blood and urine test that I had on 12 XXXXXXX 1996 showed trace amounts of blood and protien in my urine. No follow up tests were performed. I had a blood and urine test complete on 5 Dec 1997, total protien was reported as high. Tests conducted on 6 Dec 1997 showed large blood but negative for protien. Follow up blood work on 7 Dec 1997 showed hematocrit low, lymph% high; mxd high%; neut% high; lymphocytes high; INR high. Urine test on 8 Dec 1997 showed no protineuria or hematuria. Follow up urine test on 9 Dec 1997 again was negative for blood and protien. Final follow up blood work on 10 Dec 1997 had lymph% high; mxd% high; neut% low; and PT/INR high. On 16 Feb 1998 I had blood work done again which shoed low NA; CL and CO2. At this time I was also reporting to my Doctor that I had been having some real issues with leg swelling. So he gave me some stockings that I could wear at night to try and reduce the swelling (edema). He also recommended that I elevate them when I could to tey and decrease the swelling. I had more blood work done on 26 April 2000 which showed everything normal. I continued to suffer from edema in both legs. On January 22, 2001 I had bloodwork done which included creatnine, BUN; Albumin, all normal, nor urinalysis done or any other testing. I also had an appointment with an internist who completed a basic examination and determined the following: "no history of rheumatic fever or cardiac disease, she is not SAD, as for her DVT, she is no longer on birth control pills. She has not had a sedentry life style and does not have a histroy of liver or kidney disease. Physically she is a tall, 5 foot ten inch obese woman, blood pressure of 105/65, with normal first and second heart sounds. Her chest was clear, abdomen was soft. Ankle had a mild edema of about one plus. Pedal pulses were palpable. I think she has so called idiopathic cyclical edema XXXXXXX After this consult I received a second pair of elastic stockings.
My edema in my lower legs did not get better with a second pair of stockings, it only worsened. I continued to let my Doctors know, but nothing was done. I had a series of bloodwork and urine analyses completed in 2002: 17 Jul 2002 urinalysis showed trace blood. Bloodwork on 23 Jul 2002 showed low Hematocrit, urinalysis was negative for protien and blood. Urinalysis for 24 and 25 of Jul 2002 were also negative for blood and protien.
August of 2002 I applied to a life insurance company for life insurance and RRSPs. I had to complete bloodwork and urine sample as part of the apllication. Bloodwork was good but urine came back with blood in sample. I was denied for application and told that once I checked it out (I was told that it was probably an infection) that I would be able to re-apply. I waited a year (late summer 2003) and made application again only to find blood in the urine once more. (I did not tell them that I had not gone to see my Doctor about this possible urine infection the last time.)
I did not go to my Doctor this time because I was working shift work and I could not really find the time.
At this point when I went in to get a full work up done, the follow ups continued regularly and I was able to finally get a diagnosis. My edema was taken seriously and I was able to get answers.
I was transfered from the Halifax, NS area in October 2004 to XXXXXXX ON. At that time I went to establish a regular Doctor at the base I was going to be working at and requested a full blood work up and urinalysis. The results of the tests done 28 October 2004 showed trace protien and trace blood. The test was repeated 13 January 2005 and again there was trace protien and trace blood. I was then referred to an internest in Toronto and I was sent to a Neprologist in XXXXXXX by April 2006 and a biopsy completed, diagnosis confirmed as IgA Nephropathy.
From the point that I arrived in the XXXXXXX area, I was able to get things moving in the right direction. What I would like to know is could my kidney disease have been picked up earlier with better follow-ups and other testing?? If it could have been picked up earlier, how much earlier?? Thank you I look forward to your response. Please let me know which documents you would like to see and I will send them on to you. XXXXXXX XXXXXXX
Hi XXXXXXX
IgA nephropathy may present with hematuria with or without proteinuria and edema.
All the symptoms may not occur at once
Whenever body is in any stress (any infection, exertion or use of medications) IgA nephropathy can show worsening in symptoms. Due to this intermittent presentation and very minimal symptoms the diagnosis is often missed for long. This is world over.
Only thing of concern is that in the presence of significant edema. To rule out proteinuria one should not rely on urine routine examination alone and one should do 24 hrs urine collection for protein quantification. If this is also normal then it is very difficult to diagnose it.
As far as management of the condition goes generally delay in diagnosis does not lead to any damage as this condition is a slowly progressive condition and does not lead to renal failure very early.
Hope this helps.
Please write in if any query.
IgA nephropathy may present with hematuria with or without proteinuria and edema.
All the symptoms may not occur at once
Whenever body is in any stress (any infection, exertion or use of medications) IgA nephropathy can show worsening in symptoms. Due to this intermittent presentation and very minimal symptoms the diagnosis is often missed for long. This is world over.
Only thing of concern is that in the presence of significant edema. To rule out proteinuria one should not rely on urine routine examination alone and one should do 24 hrs urine collection for protein quantification. If this is also normal then it is very difficult to diagnose it.
As far as management of the condition goes generally delay in diagnosis does not lead to any damage as this condition is a slowly progressive condition and does not lead to renal failure very early.
Hope this helps.
Please write in if any query.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
So in the time line I presented, when should my doctors have started testing for protien with 24 hour urine test? Additionally, I realize that IgA Nephropathy is progressive, but my initial symptoms of blood and sporatic protien in the urine began occuring as early as 1998, which is 8 years prior to the actual diagnosis, could this have lead to lose of kidney function? At the time of the biopsy in 2006 I was at 67% in each kidney. Thanks, XXXXXXX
Hi,
In dec 97 when you had mixed reports of urinary protein some showing negative and some positive, that would have been a good time to recheck with spot urine protein estimation or 24 hrs urine protein estimation. Which would have confirmed the problem. Also in feb 98 when swelling had increased a repeat urine protein estimation could have helped.
We have to understand that in this disease the proteinuria may come and go . And may be missed that is why it has to be tested again and again.
Igan is one of the benign nephropathy and it may not show any worsening of renal functions . Only 10% patients will progress to renal failure over 10 years. But if patients have more than 3 Gm/day proteinuria in testing then the risk of disease progression increases.
Overall it cannot be commented that if Iga would have been diagnosed that time that you would have been better off. But if your blood pressure and proteinuria have remained high during this while especially because the diagnosis was missed then it could contribute to deterioration in renal function.
In patients with negligible proteinuria treatment may not change the course of the disease.
Hope this clarifies your doubt
Bye
In dec 97 when you had mixed reports of urinary protein some showing negative and some positive, that would have been a good time to recheck with spot urine protein estimation or 24 hrs urine protein estimation. Which would have confirmed the problem. Also in feb 98 when swelling had increased a repeat urine protein estimation could have helped.
We have to understand that in this disease the proteinuria may come and go . And may be missed that is why it has to be tested again and again.
Igan is one of the benign nephropathy and it may not show any worsening of renal functions . Only 10% patients will progress to renal failure over 10 years. But if patients have more than 3 Gm/day proteinuria in testing then the risk of disease progression increases.
Overall it cannot be commented that if Iga would have been diagnosed that time that you would have been better off. But if your blood pressure and proteinuria have remained high during this while especially because the diagnosis was missed then it could contribute to deterioration in renal function.
In patients with negligible proteinuria treatment may not change the course of the disease.
Hope this clarifies your doubt
Bye
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
Answered by
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