Dr. Khant Shahil Ramesh Bhai
Urology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 44-year-old male with a BMI of 26. During a recent health checkup of blood and urine, the following readings were observed. I have mentioned only the ones who have the higher readings. Protein 1+ detected in dipstick, serum uric acid at 9.2 mg/dL, MPV at 12.5 fL, FBS at 112 mg/dL, HbA1c at 5.5, cholesterol at 227 mg/dL, triglycerides at 181 mg/dL, VLDL is at 36.2 mg/dL, ALT/SGPT at 48 U/L. Serum creatinine at 1.23, increased from 0.99 tested six months back. Other than this, all others were normal. I also have been infected with hepatitis B twice and vaccinated for hepatitis B. I have been a diabetic for more than two years. The HbA1c vary between 5.5 and 6.5. The first one was done two years ago. I also have hypertension for more than five years. It is not very much under control. It varies from 135/80 to 150/100 and now it has reduced a bit to 140/90. I met my general physician who advised me to check my albumin to creatinine ratio. I tested it four times. The results are as follows: 55 ug/mg, 150 mg/g, 11.4 ug/mg, 37.5 mg/g. My ultrasonogram revealed fatty liver and cystitis. All the rest is fine. My ECG was fine. I have been advised to have a urine culture. My current medications are Telma-AM 40, Dynaglipt, Ecosprin AV 75, Levofloxacin, and CTD 12.5 mg. I am not able to understand why my albumin levels are so high and I would like to know how and when can they be rectified. I have attached reports for your further reference.
Hello,
Welcome to icliniq.com.
I have seen all your reports (attachment removed to protect patient identity). The main problem is with the serum lipid profile which is HDL (high-density lipoprotein), LDH (lactate dehydrogenase), cholesterol, serum uric acid, urine albumin-creatinine ratio which is 37.5. You are basically in the early stages of diabetic nephropathy. All patients with diabetes will suffer from this although your blood sugars and HbA1c is under control. Albumin-creatinine ratio at 37.5 is only a little bit high. I think there is nothing to worry. I think you are on the right medications because Telma-AM (Telmisartan and Amlodipine) prevents progression of diabetic nephropathy. As your uric acid is high, it may also cause renal damage and proteinuria. You need to have less protein. Reduce the non-vegetarian diet. I suggest you take tab Febutaz (Febuxostat) 40 mg once daily which reduces the uric acid levels. Take the antibiotic according to the urine culture report. As regards to the raised lipids, I suggest you add tablet Rosuvas (Rosuvastatin) 10 mg once daily. Consult your specialist doctor, discuss with him or her and take the above medicines with their consent. Also, daily exercise is a must.
I hope I have cleared your doubts. Thanks.
Patient's Query
Thank you doctor,
I want to know the following: 1) Has the damage to the kidney started? 2) Can this condition be reversed? 3) Should I consult a dietitian to have low protein in my diet? 4) My general physician told me that my prostate is enlarged despite the USG report. Please check and confirm. I have attached the reports here. 5) Can I have non-vegetarian food once a week? 6) My reports say I have uric acid at 6.5 but I have no pain in my leg. Should I retest the same? I am on Alfusin one tablet and Livotone tablet. I have been told to continue the Levofloxacin and Ornidazole despite no growth in urine culture report. Kindly advise. I am awaiting your reply.
Hello,
Welcome back to icliniq.com.
I have gone through your reports (attachment removed to protect patient identity). Yes, the kidney damage has started but it is very very mild and it is inevitable. No, this condition is not reversible. Yes, definitely diabetic renal diet would be great. No, your prostate seems normal. But, the postvoid urine is a little bit raised that is variable and can be rechecked after four months. As you have started the antibiotics, I suggest you finish the course and there is no need to stop in between. Yes, you can have non-vegetarian food once a week and it should be fine. There is no relation of pain in legs with uric acid levels. You can recheck your uric acid level after two to three weeks.
Regards.
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Urology
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