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Macular patch on feet with urine protein

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30 aug 12 i got red spot or macular patches on both feet, ,physician gave me omanacontil 40mg,30mg,20mg,10,5mg each for 10 days & lazanine& atraxcin f0r 20days & blood report shows normal ony RDw 15 & esinofills 9h& esr 17 (N). ANa negative.refered to dermatologist she gave same steroid with rantec150,manikindcv625, goutnil 1/2 teblet each day 3sep, recrrence of lession on discontinue goutnil 13 sep,biopsy done 18sep shows small vessel leucocytoclastic vasculitis to continue the gountil stop omnacontilfor six month. but pain in knee &and thereafter lession recurrence stopping the goutnil . rheumatologist Inmeun-P (painkillar), cellin 500 & goutnil 1 t alternate day.complete bloodt count with ESr ESR 10(n), MCV 103.02 (H),Screatnine 0.96 rest normal ,ANCA negative,chest xray normalprotien 1, mucus thread few, slightly hazy in urine routine, . on 13 march due MCV h gave Rejuneron od 2month, Inmeun-P (painkillar),goutnil see after 3 month. 9 june S, cretnine 0.85,HBs ag negative lipid profile normal,protein 2& occult blood 3. 9 july creatinine in random urine 87.75 mg/dl, total proteine i random urine =66.3mg/dl H and creatnine & proteine ratio =0.76 H suggested to see nephrologistwith usg abdomen. neprologist urine routine protein 3,occult blood 4,epithelial cell ocassional,amorphus deposit present, c3 c4 normal,esr 6mm,24 hr urine creatnine 15.06 & creatnine in random urine =37.91 mg/dl L, 24 hr urine protien 0.79 H & total protien in random urine =27,5 H. Neprologist advised to go for Renal biopsy for management & prognosis. pls advise shold i go for biopsy?.


Category: Nephrologist

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Category: Pediatrician
Dr. Raj Rani Mitra is online now

Expert:  Dr. Raj Rani Mitra replied 4 Days.

Hi,

Thanks for your query at DoctorSpring.com.

Any amount of proteinuria above 200 mg per day is abnormal. It should be evaluated. As the report, you have a proetienuria of approx 700 mg per day. It needs renal biopsy.

Leucocytoclastic vasculitis can involve kidney and mostly A nephropathy like situation can be seen in the kidney. You don't require to take Goutnil or Zyoric as it not appearing like gout.

Hope it helps, please feel free to discuss further.

best,
Dr. Sree Bhushan Raju
MD, DM (AIIMS), DNB, FISN, FICP, FIACM


Patient replied :

Dear Sir,
I gave the sample in fortis hospital for spot urine routine test on 03/08/13 in which Protein (method multistix) not detected but blood (multistix) 3 detected, what is reason of blood.Urine culture on same date shows polymerpho nuclear leucosites not detected, gram stain no organism detected, culture no groth, Pls advise sir i am little bit confused because biopsy of renal may damage the kidney/renal, i think biopsy iast option


Expert:  Dr. Raj Rani Mitra replied 3 Days.

The protein as per routine urine examination is nil and spot is high. It can vary from time to time and lab to lab. In fact, There is no hurry in renal biopsy and you cans till wait for few more weeks and months for renal biopsy.

The other parts of urine report only are suggestive of absence of infection in the urine.

To clarify about your doubt renal biopsy, which is a simple and safe procedure. There is no harm attributed to kidney due to renal biopsy. Its a simple 5-10 min procedure and absolutely safe. There are hardly any major complications seen out of several thousands of biopsy procedures.

It is essential to know the underlying renal condition so that the treatment can be given as per the diseases and severity. It can also give an impression over the kidney disease how it progresses during the life time.

You don't have to worry about the kidney biopsy rather the indication and timing are very important. I feel that there is no urgency in renal biopsy and you can wait and see. Meanwhile you can watch creatinine and proteinuria. If there is an increase in creatinine and worsening of proteinuria by more than 1 gm pr day, You can plan for renal biopsy as any thing less that may not support or guide you in the treatment.

Hope it helps.

Best
Dr. Sree Bhushan Raju
MD, DM (AIIMS), DNB, FISN, FICP, FIACM


Patient replied :

Dear Sir,
I am sorry to say my question remained unanswered about blood in urine (multistix) 3 detected, what is reason of blood in urine . is it related to proteinurea ? what does it indicates?should i go for another 24 hr cretinine in urine & 24 hr protein in urine test . As you have suggested that Any amount of proteinuria above 200 mg per day is abnormal.You are requested to tell that What is the abnormal value of creatinine in 24 hr urine test


Expert:  Dr. Raj Rani Mitra replied 2 Days.

Hi,

Urinary red blood cells should be checked in urine microscopy rather than blood through dip stics. So, you don't have to worry and you can check 24 hrs protein later . There is nothing like normal urinary creatinine.

It depends on protein intake , muscle mass of the body etc. what is important is its relation with the protein and to show that the urinary collection is adequate and appropriate sample for the test . Blood in the urine can be detected in urine microscopy.

Hope i have answered your question. Please feel free to discuss further.

Regards


Patient replied :

Dear Sir.
My nephrologist has suggested me stop the goutnil teblet & suggested me take the feburic 40 . He told me that goutnil has side effect on kidney in compare to feburic. Your diseases doesn't look gout. What is your opinion about it.


Expert:  Dr. Raj Rani Mitra replied 1 Day.

Hi,

Goutnil has colchicine which has anti gout property and decreases the joint pains. Where as genitive is febuxostat which decreases uric acid which is the culprit in gout. Gout nil should be used only when there is a severe joint pain for immediate relief but not for decreasing gout. Zyloric has Allopurinol which was used earlier to decrease uric acid has few side effects and febuxostat has decreased such incidences

You can safely use feburic and use goutnil only when severe joint pains are there.

Regards.


Dr. Raj Rani Mitra
Category: Pediatrician
Experience: 
M.R.C.PCh Royal College of Paediatrics and child health 2009 
M.R.C.P. Royal College of Physicians U.K. 1974
D.C.H. Royal College of Physicians, London, U.K. 1971
M.B.B.S. Calcutta University, India 1965
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