What could be the reason for the frothing of urine and the trace amount of protein in the urine?

Hello doctor,

I am a 33-year-old male and have had frothy urine with a trace amount of protein occasionally during the day via dipstick test. Although blood work shows' normal function (eGFR 79 mg/mmol and creatinine 106 mcmol/l), ultrasound and MRI show normal kidneys in the past two months. This has been a daily occurrence for at least four weeks now. No urinalysis was done other than a dipstick test at the doctor's office, which was clear twice. All other readings are normal on the dipstick except for a high pH sometimes. This usually occurs when it is cloudy, but the cloudiness is not frequent, and no blood.

There are no other symptoms, but I have been experiencing persistent intermittent fever (37.7 to 38.3 degrees Celcius) for the past three weeks. In addition, I have been waking up at night to urinate for years just once. My sleep has been interrupted in the past three months since my gut issue. The urine is less frothy when I drink more water. I had been on antibiotics and herbal supplements (Allicin) in the past week but stopped five days ago, and it still persists. Sometimes I even have pain in my testicle pain. But there is no burning sensation, and the frequency is normal. I eat a balanced diet and do not take a protein shake or exercise much. The color of the urine is light yellow. When I flush, a layer of bubbles remains, and I need to flush again. Should I request a 24-hour analysis or take this further, considering my weaker eGFR and higher creatinine value? Kindly help.

Hello doctor,

Thank you for the reply.

Can this be due to some kidney disease? The dipstick test that is done in the morning always shows trace protein. Also, I have a left-sided varicocele and some unexplained hard round bumps in the spermatic cord or epididymis. Should I consult a Urologist for this issue? Kindly help.

Hello doctor,

Thank you for the reply.

Varicocele and testicles are fine. But my persistent fever usually continues. So the urologist suggested ruling out the colovesical fistula due to the frothing and the gut issues through a CT scan.

I have attached updated blood and urine culture reports. What does positive in organism mean? Kindly help.

Hello doctor,

Thank you for the reply.

I do not have any UTI symptoms like burning or frequent urination, no blood, clear dipstick, no weird smell, and nothing seen in urine, although always foamy and sometimes cloudy. It is just showing a positive organism. My most recent axillary lymph node shows 'normal' and not reactive, but I am not sure.

I am due to have flexible sigmoidoscopy in the coming week. Is a colovesical fistula likely in this situation? My gastroenterologist said no need if CT if the dipstick is normal. Should I wait and see if the fever resolves or redo the urine test? Kindly help.

Hi doctor,

Thanks for the reply.

My doctor has suggested QuantiFERON-TB gold and chest X-ray, which I have done.

1) Does Mantoux TB still need to be done?

2) Does urine mycobacteria still need to be done if I did the blood test?

3) Or is QTB and chest X-ray sufficient?

4) How long does QTB result take?

5) I also have a non-contrast abdomen pelvic MRI taken in two weeks' time. Is this sufficient to detect, or is contrast needed?

6) Does TB present with high CRP, ESR, and WBC? Or would my most recent blood make it less likely?

7) What is the fever pattern of TB? Mine is around 37.7 to 38.2 in the afternoon from 9 AM to 10 PM usually but fluctuates.

8) Is there anything else that causes a similar presentation as TB?

9) I had this bite or maybe an itch on my calf. I scratched it a few months ago, and it took maybe three weeks to heal. It is still itchy from time to time. There were no rings or anything. Any ideas on this considering my symptom?

10) My urine culture was negative for everything but was positive for an organism that could not grow - although I have been waking up every night to urinate and have recurring cystitis-type discomfort when urinating and without too, my urine presents with a lot of bubbles or foam for a few months now. Any further test here?

11) Also, please note this all started when I took three-day antibiotics Co-amoxiclav after food poisoning, and it messed up my gut microbiome. The doctor thinks I have severe dysbiosis as I was also treated for H.pylori and another seven-day course of Rifaximin for SIBO, so three courses of antibiotics in three months could trigger a lot of infections.

12) Can ultrasound detect TB?

It would be grateful if you could address these queries one by one. Thanks.

Hello doctor,

Thank you very much for your detailed and prompt response.

I have done the QTB blood test. Do I need to do urine for mycobacteria culture in addition or not?

Or only if QTB is positive?

Can pelvic MRI non-contrast detect urogenital TB?

For urogenital TB, is it normal to have clear urinalysis except for the positive organism like what I attached?

How long does the urine mycobacteria culture test take?

I have normal ESR and CRP, and WBC, so is it unlikely I have TB?

What temperatures does TB go up to?

Do you suggest anything right now, or should I wait for the results?

Thanks.