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What Does This Lab Report In A Person With Sjogren's Syndrome?

Posted on Mon, 13 Apr 2015

Question: 42yr old XXXXXXX XXXXXXX Female with SLE, Sjergrens, Sicca, Gout, Hypo-thyroid, REM Sleep Apnea, Mycroscopic & Lymphocytic colitis, with active disease activity continuously for over 5 years even after infusion therapy.
Recent LABS:
PLT 569; Sed Rate 62mm/hr, Potassium 2.8, Anion Gap 18, BUN 24, eGFR Black 58, eGFR Non-Black 48, Alk Phos 180, ALT 143, AST 266, UA Urobilinogen 1+, UA protein (positive), Chol 236. Rheumatoid Factor positive, ANA positive, FANA Titer Homogenous 1:640,

Should I be worried? My disease activity just seems to be getting worse. I've been on lupus meds including infusion therapy & still my flares show no sign of slowing down. I've had 3 liver biopsies in 18 months & have three separate abnormal FNH they're watching. Do these new results mean I have kidney involvement now too? Advice?

Answered by Dr. Naval Mendiratta (1 hour later)

Brief Answer:
Renal involvement in lupus

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well the sort of lab reports you have sent do look like renal tubular acidosis. There is low potassium and mildly low anion gap. It is not a common manifestation of lupus or sjogrens but can be seen in rare cases. I would like to ask you a few queries before I can guide you further:

1. What are your bicarbonate levels and chloride levels

2. When you said infusion therapy..can you give me the details of the treatment you are on

3. Why exactly is liver biopsy being carried out repeatedly in your case? I could not figure out the reason..

4. Any other organ involvement in your case like the lungs or heart or brain?

5. Do you have reports of complement c3 c4,/dsdna and 24 hour urine protein?

6. Do send me the reports of your liver function tests as well

Do let me know these queries
There are a few loose ends which need to be tied
But yes there is a bit of kidney involvement but we need to see the extent of it and the therapy needs to be altered accordingly.

Await your reply
Regards
Dr naval

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Naval Mendiratta (10 hours later)

Thank you for responding Dr. Mandiratta,
I've attached all my latest labs and will answer these questions directly ...

Regards,

Answered by Dr. Naval Mendiratta (10 hours later)

Brief Answer:
Systemic Lupus Erythrematous

Detailed Answer:
Good evening

Well there are 8 images attached but all are of the same Urine report. Could not find any thing other than that. Please try and re attach it cause Urine report is not a normal one. You can also send the reports at YYYY@YYYY and address it to my name: Dr Naval Mendiratta.

Awaiting your reply

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (18 hours later)

Dr. Naval,

I truly appreciate your taking the time to respond to me. I'm going to send the attatchments to the address you mentioned above. I apologize about the mixup earlier, however I believe I've solved the issue & will attach all related info to the email I'm sending you directly.
Again, Thank you for all your observational help & diagnostic advice.
The email will arrive shortly and I look forward to your reply.
Best,
XXXXX

Answered by Dr. Naval Mendiratta (1 hour later)

Brief Answer:
Reports awaited

Detailed Answer:
Good evening

Thanks for your reply.I am waiting for the reports to be sent. Take your time. I will do my best to solve your query.

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Naval Mendiratta (50 minutes later)

Dr. Naval

I sent you an email with all the labs and answers to your questions to the address you listed in the previous message. YYYY@YYYY
in the message subject description I listed your name. Did you not recieve it? I cc'd myself in the medsage & I recieved it over an hour & 1/2 ago.
Perhaps I'll copy & paste it here to be sure.
Sent from my yahoo acct used to create this acct.
The email address is: YYYY@YYYY
I'll send it again here to this message board again
Please notify me if you've not gotten it.
XXXXX

Answered by Dr. Naval Mendiratta (4 hours later)

Brief Answer:
SLE management

Detailed Answer:
Good evening

Well yes i got the results. I got them just half an hour back. I have gone through your reports and i have a few queries, to help me tie out all the loose ends.

1. I can see your kidney function tests are on the higher side.S. Creatinine is 1.3 and BUN is 22. There is a bit of leakage of the protein in the urine as well. Although the complements are normal, there is a possibility the kidney is getting involved. I would like you to check your previous reports of S. Creatinine and urine and let me know how much they have changed. Also i would suggest you get 24 hour urine protein and urine protein creatinine ratio done to asses the amount of leakage.

2. As for the raised liver enzymes, it can very well be a part of the Lupus, autoimmune hepatitis. I am not too sure how much Biopsy will help. If we treat Lupus, it should resolve it as well.

3. I would like to know which injection was given to you. B cell ones are Belillumab or Rituximab. Since you were on trial, there is a possibility of you receiving Belilumab. But i would like you to figure it out cause if you not recieved Rituximab, it is a very good option for treatment in future

4. When you say you get disease flares, i would like to know what are the symptoms you experience?

5. Could you message me the current medications you are taking, so it will give me a fair idea on the current treatment and we can plan the further course as well.

There are a few loose ends which we need to tie up. I cant ignore the kidney function rising and we definately need to treat it aggressively.

Do let me know these queries./

Regards
Dr Naval

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Above answer was peer-reviewed by : Dr. Pradeep Vitta