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Mom of three, MD
Mom of three, MD, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 167
Experience:  Private practice pediatrician; reputation for being a superb diagnostician and caring, loving doc
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What is the association between a dropping hemoglobin count

Resolved Question:

What is the association between a dropping hemoglobin count and kidney problems in a 14 yr old girl?
Submitted: 8 years ago.
Category: Pediatrics
Expert:  Mom of three, MD replied 8 years ago.
Hi, I am Dr. Carrington, a board certified pediatrician. I am sorry that this teenager is having medical problems. One of the functions of the kidney is to make erythropoeitin, known as EPO. EPO is a hormone that tells the bone marrow to make red blood cells. A poorly functioning kidney does not make enough EPO, so the body doesn't produce enough red blood cells, which shows up in lab tests as low hemoglobin. Dropping hemoglobin in someone with kidney problems is serious; I hope this teen is getting excellent medical care, including a kidney specialist. PLEASE let me know if there are further questions I can answer. If I have answered your question, please click the green accept button. Thank you and very best of luck.
Customer: replied 8 years ago.

Will this also cause excessive protein in her urine?

And YES, we are attempting to establish an appt with both a GI doctor and a nephrologist as quickly as they can set one up.

Expert:  Mom of three, MD replied 8 years ago.
Good question. It certainly can. So she has dropping hemoglobin, protein in her urine... what other problems. Could you please tell me a bit more about her kidney problem?
Customer: replied 8 years ago.
We have monitored both for the past 10 days, the hemoglobin keeps dropping and the protein remains in her urine. The GP we have been seeing wants her to have a scope put into her stomach in addition to a colonoscopy and since the hemoglobin continues to drop, we are also to see a nephrologist. The first day of the 24 hr urine catch she only urinated once after her morning urination. The day of her doctor appt she was having to leave class about every 10 minutes to go to the bathroom. She has been running a low-grade fever (99.4) in addition. She complains of being tired.
Expert:  Mom of three, MD replied 8 years ago.
Good news that her BUN and Creatinine are normal. Sounds like in looking for a cause of her dropping hemoglobin, the doctor is sorting out whether she is losing blood through her GI tract OR whether the hemoglobin is dropping because of kidney disease. She understandably feels tired because of the anemia (dropping hemoglobin). I hope that a urine culture was sent to look for urinary tract infection- do you know the results? I will happily keep working with you; please click accept in order that I may receive credit for my time.
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Customer: replied 8 years ago.
they have checked for that and there is no UTI.
Expert:  Mom of three, MD replied 8 years ago.
Ok- has there been blood in the urine? Do you know if any of the tests have shown definite blood in the stool? Is she vomiting? Losing weight?
Expert:  Mom of three, MD replied 8 years ago.
Also, how is her blood pressure? And did she seem sick 1-2 weeks before these problems started (with sore throat, headache, fever, abdominal pain or rash?)
Customer: replied 8 years ago.

No blood in the urine. She had a low grade fever about a week prior and it has remained. Her b/p is normal.

Expert:  Mom of three, MD replied 8 years ago.
The normal blood pressure, negative urine culture and normal BUN and creatinine are very reassuring that she does not have UTI (which can cause kidney scarring and damage), does not have kidney failure, and does not have glomerulonephritis (which can cause kidney problems and is not uncommon in this age group; glomerulonephritis is often preceded by strep throat, but this does not fit well with the info you are giving me).

I can see why the doctor ordered the tests that were ordered. The frequent urination, combined with the dropping hemoglobin, made it very reasonable to look carefully with 24 hour urine, etc. It sounds like this puzzle is not solved yet; the gastroenterologist (who, as you mentioned, will need to look with a scope to try to find the bleeding site) will be very helpful. It sounds to me like you are in very capable hands; the doctor is thinking of everything, ordering appropriate tests and referring to specialists. I am so sorry you are going through this. I hope I have been helpful to you.
Customer: replied 8 years ago.
You have clarified the situation for me and helped ease my mind a bit, although I am seriously concerned. Thank you.