What Does This Urinalysis Report Indicate?

Posted on Mon, 16 Nov 2015

Question: Hi Sir, myself XXXX XXXXXXX i m consulting here for my father , his age is 58 years(weight 78 kg, blood pressure- 170/96)from the past 15 years he is suffering from diabetes, these days he is taking insulin injection. from the past one and half year he is having issues in Kidney . swelling in both legs below knee, weakness, breathlessness. we are consulting with a doctor (he is taking lots of medicine for kidney)... he said today the urea level in his body is very high and loosing lots of protein through urine and may be my father need the dialysis in coming days... i m sharing some reports finding here...
Plasma/serum urea = 154.1 mg/dl
serum phosphorous = 7.0 mg/dl
serum uric acid = 8.4 mg/dl
urinary protein 24 hours = 3510.0 mg/24 hours
B. Protein = 270 mg/dl
please suggest me what is his condition... and is the dialysis the only option?

Answered by Dr. Prasanna Heijebu (4 hours later)

Brief Answer:
Possible diabetic nephropathy

Detailed Answer:
Hello, Sir.

I can certainly understand your concern.

I have gone through your query in detail.

These lab values represent Diabetic Nephropathy ,which causes loss of protein in urine.

This can lead to chronic renal failure if not treated early.

Dialysis may not be the only option required.

At this stage drugs like Ace inhibitors will help to rely progression of Diabetic nephropathy.

Please check with your physician if he shares my view and if can prescribe these drugs to you.

The blood pressure in his case need to be grossly reduced.

It is important to keep the blood pressure under 130/80 mm of Hg.

Elevated blood pressure can also lead to elevated protein loss and renal insufficiency.

Update me with complete list of drugs of your father.

Post your further queries if any.
Thank you

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Prasanna Heijebu (21 hours later)

Hi Doctor thanks for your description. Would you please tell me is the same reason for swelling in his both legs? we are consulting to the new doctor from the past 10 days and before this another doctor treated my father since 6 months.. so i m sharing both the doctor's prescribed drugs..
=> previous doctor's drugs... 1. LAZON-5 TAB
2. RENAPHOS TAB
3. AUXITROL-CAP
4. VELCAR 400 MG
5. CETANIL-10 MG TAB
6. Q-CAR TAB
7. TOR - 100MGM TAB

=>New doctor's drugs... 1. SD Rab
2. Lipifol-D3
3. Tiniba 500
4. Clopidogrel TAB
5. Livogen Captabs
6. Deriphyllin retard 150
7. Cilnidipine Tablets 20 mg
But the new doctor's drug is not helping much .... and he told for the new blood test ... and if the Plasma/serum urea level will be high in report he will prescribe for the dialysis.
And please tell some home method so that i can take precaution to lower the Blood pressure level.

Answered by Dr. Prasanna Heijebu (14 hours later)

Brief Answer:
Dialysis can be a safer option if medical management fails

Detailed Answer:
Hello, Sir.

I can certainly understand your concern.

I have gone through the drug list in detail.

Yes, both Diabetic nephropathy, as well as Congestive heart failure(secondary to longstanding diabetes and high blood pressure) can cause swelling of feet and difficulty in breathing.

Drugs like LANZON 5mg, TOR 100, VELCAR 400, CILNIDIPINE are highly effective in controlling the blood pressure, preventing phosphate retention and edema/water accumulation in the body.

Dialysis is usually needed when patients lose about 85% to 90% of their kidney function or when they develop end-stage kidney failure.

Dialysis serves the following functions: removes waste, salt, and extra water to prevent them from building up in the body; maintains a safe level of certain chemicals in the blood, such as potassium, sodium, and bicarbonate; and helps to control blood pressure.

In case if your father does not respond fully on above prescribed medications or if there is increasing levels of Sr. Creatinine/Potassium or worsening breathlessness or generalised edema, it is wise to go for dialysis.

Also, there is no prescription of drugs like Ace Inhibitors as earlier mentioned.These drugs are usually prescribed after checking the serum potassium levels.Please check with your physician if he can prescribe the same to him, as these drugs are known to prevent renal failure by controlling the protein loss and high blood pressure.

Home measures for reducing blood pressure- You can go through the guidelines offered by Mayo clinic at the following link

XXXX

Let me know in case you have any doubts after reading the article.

Post your queries if any.
Thank you.

Post your further queries if any,
Thank you.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Prasanna Heijebu (9 hours later)

Hi Doctor thanks for your detail answer ... today i got a new report of my father,
in which Plasma/serum urea = 140 mg/dl
Serum Creatinine = 9.2 mg/dl.
Serum Potassium = 4.3 mEq/Liter
My doctor told me for the dialysis. And i asked for Ace Inhibitors then he told me that the Creatinine level is very high that is why he is not prescribing Ace Inhibitors .
So please give me your final inputs . Any thing that add to my knowledge would be great for me for caring my father.
Thanks

Answered by Dr. Prasanna Heijebu (25 hours later)

Brief Answer:
Dialysis is the best option

Detailed Answer:
Hello, Sir.

I apologize for my delayed response. Kindly excuse me.

Yes, your doctor is absolutely right.

Under 2 situations Ace inhibitors are strictly contraindicated- grossly elevated serum potassium and creatinine.

As per his latest reports, he seems to be in " Azotemia" a condition associated with impending complete renal failure if not attended in time.

Based on the above reports, Dialysis is the safest and foremost option your father can take.

Once this azotemia is taken care of with dialysis a large improvement is expected.

Post your further queries if any.
Thank you.

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Raju A.T