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Suggest Treatment For Hypertension And Persistent Proteinuria And Pus Cells In Urine

Posted on Wed, 9 Sep 2015

Question: 54 yr female, 89 kg weight, hypertensive, non-diabetic, with persistent proteinuria and 15-20 pus cells in urine, urine culture done, antibiotics taken, normal usg, ct and mri abdomen, what to do next.

Answered by Dr. Rakesh Madhyastha (1 hour later)

Brief Answer:
Symptoms

Detailed Answer:
Hello

Thanks for the query

I understand that you are having pus cells in urine. Pus cells in urine can be present in several occasions. Please get back to me with the following details in order to come to a better conclusion

1. What are your symptoms?
2. Did the culture grow any organism?
3. Why was MRI and CT scan done? Please furnish the reports
4. Please list the medications you are on currently

I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (58 minutes later)

hello dr,
symptoms are weakness and edema off n on

culture growed staph aureus which was sensitive to furantoin, linezolid and vancomycin, resistant to all other drugs, for which linezolid was taken for 10 days.

mri and ct were done concering kidneys, to rule out any gross finding

currently telmisartan-hydrochlorthiazide is being given for blood pressure.

dr, i too am a doctor, md microbilogy, the above querry is regarding my mom.
we went to some nephrologist, and he feared us saying that kidneys are only 50% functional, and asked us to get a biopsy done.
proeinuria of my mom keeps fluctuating, from nil,+1 to +3
still there are 16-18 pus cells even after antibiotic therapy.

my husband is md, medicine, passed this year.

what i think is dat its coz of hypertension.
but i am worried about pus cells and proteinuria.
i am planning to get a repeat culture done.
her RFT is normal.

my concern is dat is she really landing into renal failure, as told by nephrologist, dat only 50 % kidney is functional, and filters are destroyed dats y having proteinuria.

Answered by Dr. Rakesh Madhyastha (3 hours later)

Brief Answer:
Urosepsis

Detailed Answer:
Hello

Thanks for the query

If the RFT is normal then I dont think it is right to say that the kidney is functioning only 50%. It looks like your mom is suffering from urosepsis and I recommend you to do the following

1. The persistant WBC in urine signifies that there is still residual infection present. I recommend Tab Nitrofurantoin 100 twice daily for 14 days followed by prophylactic dose of 100 mg once at night. I also suggest you to get a repeat urine culture

2. Proteinuria will be present during an infection, do not worry about it now. Filters destroyed during infection will regenerate

3. I suggest you to stop Telma, we do not recommend Telma during urosepsis as you will know it reduces the GFR. Calcium channel blocker like Amlodepine is ideal at this point, after successful treatment she can be back on Telma

4. Gynaec examination should be done to rule out secondary causes of urinary tract infection

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (2 hours later)

Thanks for ur precious advice Dr
We had already tried amlopidine but she developed severe side effects like chest constriction, edema got doubled up,so we had to stop it, is dere any alternative to amlodipine.

Answered by Dr. Rakesh Madhyastha (11 hours later)

Brief Answer:
Cilnidipine

Detailed Answer:
Hello

I recommends cilinidipine instead of amlodpindine.

Regards

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. Chakravarthy Mazumdar