Question: Just received the following UA back (see p2) which shows UTI: https://app.box.com/s/8rtrwedik4w7csbla3w9
I am asymptomatic. No known cause, zero risk behavior and no past hx of UTIs. I am an active and otherwise healthy 54-year male. Latest (04-14) eGFR is within range (99) and recent renal doppler U/S was normal as well.

I feel this dx pretty much describes me: http://www.nlm.nih.gov/medlineplus/ency/article/000520.htm
but am unsure as to treatment.

I was taking 4-6g/day of pure K citrate as a prophylaxis for kidney stones, but had recently stopped it for fear it would cause hyperkalemia since I'm taking both Losartan and Carvedilol for HTN which can cause excess K. By the way, I believe my uric acid is elevated because the Losartan (started about 2 weeks ago), as it is a known uricosuric agent.

I am now thinking I should resume K citrate in light of this since it's important to keep the urine alkaline when I have a risk for stones. I am going to do a repeat the UA tomorrow since it's been two weeks to see if the infection is still present.

I am about to undergo a parathyroidectomy which should alleviate the risk of future stones, but in the meantime seek help as to treatment, if any. I am concerned it may be due to infected kidney stones, as the test showed calcium oxalate crystals which was the same as the stone I passed in 2012. Also, the prevalence of RBCs even though this is not visible to me. Also, on my CBC from a month back, my eosinophils were slightly elevated (now normal @ 4). I wonder if this is related due to infection?

Other than OTC treatments (K citrate, cranberry extract, increase hydration, etc.) is there anything else you can think of and if necessary, would abx be ultimately necessary to prevent this from worsening and infecting the kidneys?

Or should I wait for the repeat UA results first and then see?

Please advise.

Did you review my results? Please review if you haven't.
Again, here is the link - please copy and paste into your browser: https://app.box.com/s/8rtrwedik4w7csbla3w9

I heard back from my local physician. His assessment: "no UTI, less than 10,000 col/ml is negative/contaminant. There are no eos in the urine, no WBC’s either, small nitrates could be dietary."

However, RBCs in urine abnormal. I passed only one stone back in 2012, haven't had any others. I have hyperparathyroidism which is the likely cause and will be having a parathyroidectomy to remove the adenoma.

I was told by the surgeon to stop Vit D and calcium supplements, however, I read that no calcium is just as bad as too much.

What is recommended now?

Pls advise.

Thank you.

I will have the results to the repeat UA early next week.

It is my belief that the elevated urinary uric acid is likely due to the Losartan 50mg as it works as a uricosuric acid (increases urine uric acid as it lowers serum uric acid), although that's not what I'm taking it for.

As UTI is no longer my concern, the concern now is the elevated RBCs (11-30 seen). Again, I am asymptomatic and I do see any blood in my urine.

Pls advise.

Please review my repeat UA donw exactly 2 weeks from the original one: https://app.box.com/s/k3bp5kddoee865pyqv5u

All urine markers 100% normal.

If this was a continuing issue, you would think it would've lasted or progressed. Makes me think the sample was contaminated? Very strange. The only concern outside of what we've discussed is that maybe the Xarelto, being a anticoagulant, could be causing possible hematuria. I had a renal ultrasound recently done which was normal and my eGFR is normal. Further thoughts?