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DrRussMd, Board certified internist
Category: Urology
Satisfied Customers: 65289
Experience:  In internal medicine we deal with prostate, bladder and kidney diseases, including cancers.
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I'm looking for other opinions. I'm a 24 year old African

Customer Question

Hi there! I'm looking for other opinions. I'm a 24 year old African American female who has Ankylosing Spondylitis. I have been on Remicade for the past 2 years with great results although recently my fatigue has gotten severe again and I just don't feel well. My back hurts on the right middle and it doesn't go away. My urge to go to the bathroom has also increased and I've been having accidents, this has been happening for a couple months. After looking at my labs (pretty normal) and my urine for the past few months the only abnormality is that I've had consistent traces of protein. Labs are all normal except for my GFR which has been dropping but is still in the normal range. My doctor said I was find and ignored any and all concerns. I had an ultrasound of my kidneys and bladder done. My kidneys were unremarkable and my bladder showed thickening of the wall. They checked to see if I had/have a UTI and although my urine sometimes shows I could the cultures were all negative except for the last one. I now have some blood after I pee. (I have a scope coming up) I saw a nephrologist who said everything is probably fine to and I should just follow up every year or so? Hmm This does NOT sit well with me. I know my body and intuition. Something isn't right. She said I could have a kidney biopsy if I feel it's important. I feel it is. Could this be an early sign of something kidney related or possibly even a sign of Amyloidosis? I would rather have a biopsy done and have it show nothing then to not do it and have an issue come up in the future. I hate when doctors feel like I'm nervous or concerned for no reason. It makes me fee like a hypochondriac, which I am NOT. I just want to feel better and know what's going on in my body. Someone please help me feel less crazy!!
Submitted: 1 year ago.
Category: Urology
Customer: replied 1 year ago.
Added some labs and results
Customer: replied 1 year ago.
Hello??? Anyone...
Expert:  Dr. David replied 1 year ago.

This is Dr. David

if your eGFR or estimated GFR has been dropping, this means your creatinine levels is most likely rising, since eGFR is estimated from your creatinine levels, your age and sex and race.

increased exercise, weight lifting, or inflammation of your muscles from myositis can cause your creatinine levels to increase.

increased creatinine in your blood can lead to increased protein in your urine

you should get blood creatinine phosphokinase blood levels checked to see if you might have myositis inflammation of your muscles which can cause back pain.

if you are worried about your kidneys, get a biopsy of your kidneys to check for nephritis or inflammation of your kidneys.

amyloidosis would be rare and unlikely.

you only have a trace amount of protein in your urine.

Remicade can cause back pain and muscle aches and myalgia muscle aches as well as common side effects

let me know if you have questions.

Expert:  DrRussMd replied 1 year ago.


GFR in the normal range is normal.

You not stated you have an elevated creatinine. A normal creatinine on a spot test, however, does not indicate normal kidneys, necessarily. Your normal ultrasound goes against medical renal disease.

There is no indication for kidney biopsy at all here. The risk would far outweigh any benefit and it would be thus dangerous do to at this point.

Increased creatinine does not cause increased protein, although they often occur together.

The indicated test here is a 24 hour urine collection, NOT anything else.

This will give an accurate creatinine , protein and GFR.

Ask for that.

Your dip stick tests are not totally accurate on any of these parameters, and an eGFR in the normal range, even if low normal, is not indicative of a problem.

I am a double board certified clinical US doctor. Nephrology and rheumatology are both part of my board certification that I must test in, per the American Board of Medical examiners. See my profile.

Please click a positive rating.

Find me, Dr. Thomas, in medical by request any day.

I will always give you safe, accurate, precise and comprehensive answers, clinically accurate according to medical standard of care, promptly.