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What Causes Recurrent Infection And Elevated CRP And Creatinine Levels?
Question: My husband has mesothelioma, has had the EPP trimodal therapy,. but has a recurrence, and has been having chemo treatment. He has been in hospital for 2 weeks now, since having been admitted with a slight temperature. His symptoms have been treated, and have improved, but he has a persistant elevated CRP of around 150, and creatinine of 150, and doctors don't know what his problem is. They have treated him for all common bacterial infections, and they wonder if it could be an uncommon infection, or a fungus he has picked up as he has severely compromised immunity. A CT kidney scan was clear, but a CT chest scan mentions alveolar infiltrates. There is no solid tumour. They intend to do a endo broncoscopy in the next few days. Could this be a new growth / tumour, or is it more likely an infection?
Brief Answer:
Infection is more likely.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Possibility of infection is more in your case.
Alveolar infiltration is classical finding of consolidation (pneumonia).
And his low grade fever and high CRP are also seen in pneumonia.
So possibility of tumour /growth is less likely in his case.
But to confirm the infection, you need to proceed with bronchoscopic evaluation.
In this biopsy and XXXXXXX (bronchoalveolar lavage) culture and sensitivity are needed.
Biopsy will rule out tumour and XXXXXXX culture will isolate the causative organism and sensitivity report will guide about effective antibiotic treatment.
So get done bronchoscopic evaluation.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your husband. Thanks.
Infection is more likely.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Possibility of infection is more in your case.
Alveolar infiltration is classical finding of consolidation (pneumonia).
And his low grade fever and high CRP are also seen in pneumonia.
So possibility of tumour /growth is less likely in his case.
But to confirm the infection, you need to proceed with bronchoscopic evaluation.
In this biopsy and XXXXXXX (bronchoalveolar lavage) culture and sensitivity are needed.
Biopsy will rule out tumour and XXXXXXX culture will isolate the causative organism and sensitivity report will guide about effective antibiotic treatment.
So get done bronchoscopic evaluation.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by :
Dr. Prasad
Thankyou, your answer is very helpful, and encouraging.
Do you have any idea why he would still have the high creatinine level.....about 150 at the moment. When he was admitted to hospital it was 268, so it has come down, but still not right. At that time he was given a catheter, and frusemide.....he lost 5 kg over 2 days, and felt a lot more comfortable.
Would the kidney function and CRP be connected, or would it be 2 separate problems?
Do you have any idea why he would still have the high creatinine level.....about 150 at the moment. When he was admitted to hospital it was 268, so it has come down, but still not right. At that time he was given a catheter, and frusemide.....he lost 5 kg over 2 days, and felt a lot more comfortable.
Would the kidney function and CRP be connected, or would it be 2 separate problems?
Brief Answer:
Both, CRP and creatinine might be connected.
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Both, creatinine and CRP might be connected to each other.
CRP is marker of acute infection. And in acute infection, kidney functions tend to alter and it is known as septicemic acute renal failure.
So high CRP (infection) can cause rise in creatinine level.
Please let me know
1. I am practising in XXXXXXX And here we use reference value of creatinine in mg/dl unit. And in this unit normal range of creatinine is 0.7-1.3 mg/dl. His report of creatinine must be carrying other unit. So please let me know the unit and normal range of creatinine in that unit.
2. Was he having decreased urine output at the time of infection?
3. What was your previous creatinine level before admission?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your husband. Thanks.
Both, CRP and creatinine might be connected.
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Both, creatinine and CRP might be connected to each other.
CRP is marker of acute infection. And in acute infection, kidney functions tend to alter and it is known as septicemic acute renal failure.
So high CRP (infection) can cause rise in creatinine level.
Please let me know
1. I am practising in XXXXXXX And here we use reference value of creatinine in mg/dl unit. And in this unit normal range of creatinine is 0.7-1.3 mg/dl. His report of creatinine must be carrying other unit. So please let me know the unit and normal range of creatinine in that unit.
2. Was he having decreased urine output at the time of infection?
3. What was your previous creatinine level before admission?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you again for your helpful answer.
I am not sure what unit they use here in Australia for creatinine, but normal for a male is around 100. In the last blood test before this happened his creatinine was 104.
When he was admitted to hospital he had normal output .....but he was extremely short of breath. When they put him on frusemide he had increased output, and it helped the shortness of breath.
He only has one lung, as his lung, chest lining, pericardium, diaghram and ribs were removed during his EPP operation 18 months ago.
The chemo he has been having since the recurrence of his mesothelioma ( Allimpta, Cisplatin, Avastin ) could cause kidney problems, but in this instance the CT scan of the kidneys was clear. So it is very complicated.
Also, we live in a rural city, which is where he is in hospital, he has his chemo in a larger city 1 hour from here, and his operation was done in Sydney, so there are a lot of doctors involved, but communication between them is lacking.
Your explanation of the connection between CRP and creatinine makes sense....I wish the doctors here would take more time to explain!
Thankyou again, and I would be glad of any more comments you would have.
I should have said that some parts of his ribs were removed in his operation, not all of them!
I am not sure what unit they use here in Australia for creatinine, but normal for a male is around 100. In the last blood test before this happened his creatinine was 104.
When he was admitted to hospital he had normal output .....but he was extremely short of breath. When they put him on frusemide he had increased output, and it helped the shortness of breath.
He only has one lung, as his lung, chest lining, pericardium, diaghram and ribs were removed during his EPP operation 18 months ago.
The chemo he has been having since the recurrence of his mesothelioma ( Allimpta, Cisplatin, Avastin ) could cause kidney problems, but in this instance the CT scan of the kidneys was clear. So it is very complicated.
Also, we live in a rural city, which is where he is in hospital, he has his chemo in a larger city 1 hour from here, and his operation was done in Sydney, so there are a lot of doctors involved, but communication between them is lacking.
Your explanation of the connection between CRP and creatinine makes sense....I wish the doctors here would take more time to explain!
Thankyou again, and I would be glad of any more comments you would have.
I should have said that some parts of his ribs were removed in his operation, not all of them!
Brief Answer:
Has he ever undergone 2d echo?
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
CT scan will not pick up functional defect. CT detects only structural defect.
Creatinine is functional measure of kidney and, infection this suggest functional defect.
So CT scan will not be important to make a diagnosis.
He is improved with frusemide, so possibility of heart failure is more.
So please let me know
1. Was it only CT scan or functional scan of kidneys?
2. Has he ever undergone 2 d echo to rule out heart failure?
3. Is he having Pulmonary hypertension?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wishing good health to your husband. Thanks.
Has he ever undergone 2d echo?
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
CT scan will not pick up functional defect. CT detects only structural defect.
Creatinine is functional measure of kidney and, infection this suggest functional defect.
So CT scan will not be important to make a diagnosis.
He is improved with frusemide, so possibility of heart failure is more.
So please let me know
1. Was it only CT scan or functional scan of kidneys?
2. Has he ever undergone 2 d echo to rule out heart failure?
3. Is he having Pulmonary hypertension?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by :
Dr. Yogesh D
Hello again
He only had the CT scan of the kidneys, this doesn't seem to be an issue any more...I guess that is because, as you explained, the creatinine level is due to the CRP, so that is what they are working on. They did the kidney scan right at the start, to rule out a kidney obstruction .
Yes, he did have a heart ultrasound, as they wanted to rule out heart failure, and, thankfully that was fine.
No, he does not have pulmonary hypertension.
You have helped me to understand his condition, and we will see what they find when they do the endo broncoscopy.
He only had the CT scan of the kidneys, this doesn't seem to be an issue any more...I guess that is because, as you explained, the creatinine level is due to the CRP, so that is what they are working on. They did the kidney scan right at the start, to rule out a kidney obstruction .
Yes, he did have a heart ultrasound, as they wanted to rule out heart failure, and, thankfully that was fine.
No, he does not have pulmonary hypertension.
You have helped me to understand his condition, and we will see what they find when they do the endo broncoscopy.
Brief Answer:
Yes get done bronchoscopic evaluation.
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Yes, get done bronchoscopic evaluation to rule out tumour and confirm infection.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Do let me know his progress.
Wishing good health to your husband. Thanks.
Yes get done bronchoscopic evaluation.
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Yes, get done bronchoscopic evaluation to rule out tumour and confirm infection.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Do let me know his progress.
Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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