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View Full Version : UTI and flank pain, want some in sight.



lcasnyder
06-27-2008, 09:45 AM
I was to my primary physician yesterday and found out I have a really bad UTI, I have also been having a sore throat off and on, and pain under my ribcage in the front. I am not sure if I should call the Rheum. and let them know what is going on as well. She put me on 10 days worth of Cipro. I had a fever of 99.3, yesterday. My blood pressure is not high but it is higher than normal. I have some pitting in my legs as well. Would like your opinion. Thanks.

Saysusie
06-27-2008, 10:02 AM
I would mention the pain under your rib cage to your rheumatologist. Especially if it is painful upon breathing or taking a deep breath and your elevated blood pressure (which could be just stress).
One of the most common symptoms of Lupus is a low grade fever such as yours, but that may also be due to the infection (infections tend to cause low grade fevers - the body is trying to fight the infection). The sore throat could be due to a number of issues, this is also something that you should discuss with your doctor.
Let me know what your doctor says.

Peace and Blessings
Saysusie

Oluwa
06-30-2008, 05:49 AM
Hi lcasnyder..

It's been three, any improvement? Hope so...sough tout your doctor as Saysusie suggested..

Hope today is better..hugs.
Love,
Oluwa

lcasnyder
07-01-2008, 10:29 AM
Things have not gotten any better. I am having alot of pain in my kidneys. I called the Rheum. after I got the results from the doctor about the culture. The culture came back with no specific bacteria. They now want me to come in for a vaginal culture. I am at a lose here. I don't understand why they are doing a vaginal culture. I don't understand why the Rheum. hasn't gotten back to me. The other night I was having slight pain in my chest as well as the pain in my kidneys. I just feel like I should be worried about this and just let nature take its course. I am getting know where with the physicians at least that is how I feel. I am on day 5 of the antibiotic and feel no different, if anything I feel worse. I don't know what to do anymore.

Saysusie
07-01-2008, 11:17 AM
When are you supposed to go in for the vaginal culture? Between now and then, make a list of your symptoms, how they feel, where you feel the pain, when the pain is most severe, etc. Usually, the first test is a urinalysis. Urine culture is often done to identify the organism causing infection and to determine which antibiotics will be effective. For women, a sample of vaginal discharge is examined on a slide using a microscope.
Infection can be either Cystitis or Urethritis. Cystitis is defined as inflammation of the urinary bladder. Urethritis is aninflammation of the urethra, which is the passageway that connects the bladder with the exterior of the body. Sometimes cystitis and urethritis are referred to collectively as a lower urinary tract infection, or UTI. Infection of the upper urinary tract involves the spread of bacteria to the kidney and is called pyelonephritis.
When cystitis (bladder infection) is suspected, the doctor will first examine your abdomen and lower back, to evaluate unusual enlargements of the kidneys or swelling of the bladder. The next step in diagnosis is collection of a urine sample. The procedure differs somewhat for women and men. Laboratory testing of urine samples can now be performed with dipsticks that indicate immune system responses to infection, as well as with microscopic analysis of samples. Normal human urine is sterile. The presence of bacteria or pus in the urine usually indicates an infection. The presence of hematuria, or blood in the urine, may indicate acute UTIs,kidney disease, kidney stones, inflammation of the prostate (in men), endometriosis (in women), or cancer of the urinary tract.
Female patients require a pelvic examination as part of the procedure to obtain urine specimens. The patient lies on an obstetrical table with legs in thestirrups. The doctor first takes a vaginal culture smear. The patient is then asked to void while lying on the table. The first five to 10 ml are collected to test for urethral infection. A midstream urine sample of 200 ml is thenc ollected to test for bladder infection.
In women, a vaginal bacterial count that is higher than those of the two urine samples, indicates vaginitis. A high bacterial count in the first urine sample indicates urethritis. A count of more than 104 bacteria CFU/ml (colony forming units per milliliter) in the midstream sample indicates a bladder or kidney infection. A colony is a large number of microorganisms that grow from a single cell within a substance called a culture. Bacterial count can be given in CFU or colony forming units.
With kidney problems, sometimes symptoms occur but are very general and difficult for the doctor to connect to the kidney. For example, a general feeling of illness (malaise), loss of appetite, nausea, or generalized itching may be the only symptoms of chronic kidney failure. In older people, mental confusion may be the first recognized symptom of infection or kidney failure. Symptoms that are more suggestive of a kidney or urinary problem include pain in the side (flank), swelling of the lower extremities, and problems with urination.
Pain caused by the kidneys is typically felt in the flank area, which is in the back, just at the lower edge of the ribs on either side of the spine. Pain caused by the kidneys tends to be sharp, severe and occur in waves.It is rare for the kidneys to cause dull, aching pain. People sometimes equate back pain with kidney pain, but dull aching pain in the back -- especially the lower back or the middle of the back -- is usually due to muscles, ligaments, or even vertebrae and disks in the spinal column. Musculoskeletal pain typically gets worse with movement, and is relieved by heat or massage.Pain caused by kidney infection (pyelonephritis) is related to infection and inflammation within the kidney tissue. Infection causes the kidney to swell, and stretches the pain-sensitive capsule surrounding the kidney, leading to a sharp, aching pain.
The two medical terms for the kidney disease that occurs in systemic lupus erythematosus are lupus nephritis or lupus glomerulonephritis. There are very few signs or symptoms of lupus nephritis and, more importantly, it does not cause pain in the abdomen or back as does kidney infection! However, when protein leaks from the kidneys, it is eliminated from the body in the urine, there is usually foamy, frothy urine and you are getting up to urinate during the night. All of these symptoms can suggest excessive protein loss.
Since you are experiencing such pain in your kidney area, your doctors are suspecting some type of infection more than nephritis - hence the vaginal culture.
However, it is still important, at you next visit, to insist that you doctor check the cause for your chest pains. Do not let them bypass this issue. Please keep us advised!

Peace and Blessings
Saysusie

lcasnyder
07-01-2008, 01:11 PM
I had both blood and protein in my urine last week, when they did the UA. They sent that sample out to see if what bacteria was present and no specific bacteria was found. I am having awful pain in my flank area. I have no appetite. I have no desire for anything. I am peeing between 3-4 times a day. I have yet to have to get up through the night. The pain in exceptionally worse at night when I lay down. I am having a lot of pain today, no matter what I do. The pain comes in waves, it is ok and then it gets really painful. I am nauseated as well. I been having numerous bowel movements today as well. It is like my body is trying to eliminate everything that is in it. I still have slight pitting in my legs. I have yet to hear anything from the Rheum. I feel like I am playing a waiting game. The only good thing about today is that my sister-in-law went into labor and am waiting to hear what she had. I am really tired as well. I am going to bed at like 10 p.m. and waking up around 10 a.m. and am ready to take a nap about 2 hrs. later. I have two small kids, but they don't wear me out that bad. I just really feel like something is really wrong. I felt this way before I was diagnosed with Lupus, like something was really wrong. I had to fight with the dr.'s for about 2 yrs. until I found one that would listen. I just feel like they are blowing my off right now. I know that my kidney are not something to play around with especially when Lupus is involved. My other concern is the fact that the test that confirmed my diagnosis of Lupus was the double stranded dna. I have been told that this test usually indicates that there is organ involvement. Hence my worrying about my kidneys. If I shouldn't be worried, say so, but I still feel like something is really wrong.

laurid8967
07-01-2008, 02:21 PM
lcsnyder -
Im sorry to hear of your pain and feeling lousy...do you have a temperature? Either way, how about going to the emergency room? First off, you'll get an answer right away, and any infection they may give you a power blast of IV antibiotics to et you started. Kidneys are nothing to mess with - particularly with lupus. Just tell the ER doc you are on antibiotics and are STILL in alot of pain, feel really sick, etc. This issue is definately ER warranted. Dont wait for the others....
Love Lauri

Saysusie
07-02-2008, 07:55 AM
lcasnyder:
I agree with Lauri, the continued pain is something that should be dealt with right away. Perhaps the emergency room is a good way to get some immediate results.
We have no way of knowing if you should be worried or not, but, as I've mentioned before, some of the symptoms that you've described do warrant immediate attention by medical professionals.
If you do take Lauri's advice about the emergency room, please let us know what was done for you and how you are doing.

Peace and Blessings
Saysusie

lcasnyder
07-10-2008, 08:08 AM
Here is an update. I called the Rheum. I was given an appt. for yesterday. On my way down there I developed an awful pain in my lower right pelvis and I also had to pull over along side the road to throw up.

I get to the appt. and the doctor examines me. I tell him that I have been having alot of bone and muscle pain. I am extremely tired. I am having problems falling asleep and then when I do I have a hard time waking up. I don't have an appetite again. I told him about the urine. I have had blood in urine twice.

He proceeds to tell me that he thinks that the lupus is quiet, but wants me to go to the ER to have them do some labs and look into the pain I am having in my lower pelvis.

So, I go the ER...

Once I arrive at the ER no one was there. They took me back to the URI-care center. I give them a urine sample, they send me for a CT scan, and drew blood. The urine came back with mild Leuk. Est., the Epi. cell were elevated, and there was 1+ bacteria. The blood work showed an elevated SED and CRP. My EOS and my MPV were low. The C3, C4, and double stranded dna, and my pap results won't be back for 48 hours the doctor told me. She also left me know that I have swollen lymph nodes in my abdomen. I am concerned about this because of my spleen being enlarged. They didn't seem to concerned with this.

I go tomorrow to see my primary physician. I am also concerned because off and on my sugars have been screwy. All day on Monday I wasn't able to get my sugars out of the 70's. The doctors did a GTT test two weeks ago and my numbers were fine with that for them, but when I got home after doing the 3 hour test. My sugar was 69 and I found out that the last sugar for them was 91. I don't really know what to think here people. I know I feel like something is really wrong again, like I did when I was persistent enough until I found out I had Lupus. I feel like I am being blown off now because I have the Lupus diagnosis. The ER doctor said to me numerous time; "Oh it is just related to the Lupus." The Rheum. seems to think that my Lupus is quiet. Well I don't think that my Lupus is quiet if my SED and CRP are elevated. I don't know what the double stranded dna has to say yet, but I just feel like something is up.

I have a lymph node on the back of my neck that they biopsied by in Feb. It came back fine. I am now concerned again though, because my spleen was enlarge, I know have enlarged lymphs in my ab. What would you think about all of this.

The only good thing in the ER was they actually gave me some pain meds.

laurid8967
07-10-2008, 11:06 AM
Hey there -
Glad you let us know what was going on....I know Saysusie will be here with more precise and detailed info, but I do know this: Lymph nodes swell when there is infection - any kind of infection. I also know that sometimes elevated CRP and sed rate do not correlate with how we are feeling - but often times it can. It sounds to me (and, obviously, Im no doctor) that there is a kidney/bladder infection (bacteria 1+) which is causing the inflammation (elevated CRP and sed rate) and causing the lymph nodes to swell. The infection could have caused a flare, and the fatiigue, joint muscle pain could be from that.
I am not comfortable, however, with them not being more concerned about your kidneys, and just saying, "its due to the lupus". You may need some stronger lupus meds to get any kidney problem under control. Im glad you got pain meds - kidney problems hurt like HECK!!
Be persistent - dont let them tell you that you are fine, when there is obviously something going on...
I hope you feel better soon - and get some answers...
Love Lauri

Saysusie
07-10-2008, 12:25 PM
It is not uncommon for Lupus to cause swelling and inflammation in the lymph nodes. The body's immune system is a network of cells and tissues responsible for clearing the body of invading foreign organisms, like bacteria, viruses, and fungi. Antibodies are special immune cells that recognize these foreign invaders, and begin a chain of events to destroy them. In an autoimmune disorder like Lupus, a person's antibodies begin to recognize the body's own tissues as foreign. Cells and chemicals of the immune system damage the tissues of the body. The reaction that occurs in tissue is called inflammation. Inflammation includes swelling, redness, increased blood flow, and tissue destruction. One of the systems that often becomes swollen in Lupus are the Lymph Nodes.
However, there are, also, a large number of conditions that could cause swollen lymph nodes; bacterial and viral infections are among those conditions. It is hard to say which factor is the cause, in your case.
Inflamed nodes by themselves are not a major concern, but since you have symptoms of Lupus along with enlarged lymph nodes, this should be of some concern to your doctor.
You should be concerned under the following circumstances:
* If the swelling of the nodes lasts for more than 2 weeks or you have any symptoms such as weight loss, night sweats, fatigue, or prolonged fever.
* If the nodes are hard, fixed to the skin, or are growing rapidly.
* If you can feel swelling close to your collarbone or in the lower part of the neck.
* If the overlying skin is red and inflamed and you suspect an infection.

Now, If infection is the cause of your swollen lymph nodes and the issue isn't treated, these complications might occur:
* Abscess formation. An abscess is a localized collection of pus caused by an infection. Pus contains fluid, white blood cells, dead tissue and bacteria or other invaders. An abscess may require drainage and antibiotic treatment. An abscess may cause significant damage if it involves a vital organ.
* Bloodstream infection (sepsis). A bacterial infection anywhere in your body can progress to sepsis, caused by an overwhelming infection of the bloodstream. Sepsis may result in organ failure and death. Treatment involves hospitalization and intravenous antibiotics.

With reference to your urine tests; Leukocytes are simply white blood cells and they are often a sign of infection. Leukocyte esterase (LE) is a urine test for the presence of white blood cells and other abnormalities associated with infection. White blood cells in the urine usually indicate a urinary tract infection. The leukocyte esterase (LE) test detects esterase, an enzyme released by white blood cells. Positive test results are clinically significant. The LE test is also used to screen for gonorrhea and for amniotic fluid infections. The combination of the LE test with the urinary nitrite test provides an excellent screen for establishing the presence of a urinary tract infection (UTI). A urine sample that tests positive for both nitrite and leukocyte esterase should be cultured for pathogenic bacteria.

Pyuria is defined as 8 or more leukocytes per cubic millimeter, this translates into 2-5 leukocytes per high power field on a slide.(microscopic evaluation). The assessment of pyuria however is imperfect. The leukocyte count on a routine urinalysis can be affected by many factors that alter the concentration of the urine. Furthermore, error may be introduced by variation in the amount of fluid that is eventually placed on the slide.
A second test that assesses the leukocyte esterase content on a rapid dipstick test is also used to predict pyuria. This dipstick test is 94% specific with 2-4% false positives. Substitution of this test for the gold standard microscopic evaluation may prove to be cost effective, yet , other information on the microscopic evaluation may be lost. When in doubt a culture is sent.
Now, a prominent feature of Lupus Nephritis (Kidney damage) is Interstitial leucocyte infiltration. Interstitial leucocyte infiltration in lupus nephritis, predicts deterioration of renal function. The mechanisms that underlie the accumulation of leukocytes in the interstitium of the kidney of SLE patients is not known.
In Systemic Lupus Erythematosus (SLE), it is difficult to differentiate between exacerbation of disease and infection. C-reactive protein (CRP) has been used to differentiate between lupus flare and infection, as in SLE, CRP levels are normal, while in infection, it is elevated. SLE flares are rarely reflected by elevated C-reactive protein (CRP). CRP rises rapidly in response to infections and tissue injury, and CRP measurement is widely employed as a marker of ongoing inflammation.
Sedimentation rate, also referred to as sed rate or erythrocyte sedimentation rate, measures the speed at which red blood cells settle to the bottom of a glass tube. The presence of certain abnormal proteins in the blood can cause red blood cells to stick together and sink to the bottom more quickly. An elevated sed rate is not specific to any one disease, but does happen often in Lupus. Other possible causes include:
Infection, Inflammatory diseases (such as rheumatoid arthritis and lupus)
Blood cancers (such as leukemia and lymphoma), and Cancer that has spread (metastasized).
Elevated ESR and CRP (C-Reactive Protein) are markers of inflammation. They can be caused by a wide variety of diseases(including Lupus), and by themselves, are not diagnostic of any single disease. Your results, as Lauri mentioned, may be due more to infection and inflammation than disease activity. I don't think that you are being brushed off, based upon the fact that they are ordering tests. Unfortunately, a lot of your issues may be related to your Lupus, but I agree that they should not use your Lupus as a dumping ground. Continue to insist that the tests be run and that you be given the results and that your symptoms be treated.
I hope that you feel better very soon. You are not alone, we are all here for you.

Peace and Blessings
Saysusie

lcasnyder
07-14-2008, 05:30 PM
The hydroxychlor the Rheum. has me on, could that be the cause of all my abdominal pain. I haven't take the hydroxychlor for about 5 days now and I am starting to feel better in my stomach. I don't know if that can cause you to have stomach issues or not.

dlrfoto
07-14-2008, 06:39 PM
I was on hydroxychlor for a few days and I had such severe abdominal pain which wrapped around to my back that I had to stop taking it. I felt like I needed to go to the bathroom, throw up and pass out all at once. I also broke out in a cold sweat! It was all very horrible and painful, not to mention scary. I can't swear those symptoms were side effects from meds but it seemed likely.

lcasnyder
07-14-2008, 09:07 PM
dlrfoto,
I have to say that it sounds exactly like me. I have been on it alot longer than that. I have been taking it since April. I have stopped taking it. I didn't notify the Rheum. yet, but I am starting to feel better without it. I still have joint pain, fatigue, and all, but I don't have that awful abdominal pain.

laurid8967
07-15-2008, 04:53 AM
OK, ladies, Im not an expert...But if youre not going to take your Plaquenil, you really need to tell your doctor, so maybe they can prescribe something else. I know the abdominal pain has stopped, but you dont want to go into a full lupus flare either...that can be very dangerous.
Im not trying to tell you what to do...we all respond differently to different meds - Im just saying PLEASE keep your doc notified. I would hate to see either one of you develop serious complications from this disease..
Keep us posted and hope youre feeling better soon!
Love Lauri

lcasnyder
07-15-2008, 07:08 AM
Thanks laurid8967.
My primary physician knows that I have stopped I talk to her today. She and I are looking into something different and even a different Rheum. I just don't feel like he hears me when I talk. I am trying to explain things to him and he is just worried about writting his notes and getting me out the door. I just don't feel like he is doing everything he can or could nor is he putting the effort or sincerity into the appt. when I go.

laurid8967
07-15-2008, 12:51 PM
Good for you, lc -
Unfortuanltely, there are some lousy rheumatologists out there...I dont understand it, really, why did they go into this field if they dont know anything about this stuff? At least your primary knows the deal...
I hope you find something soon that helps your lupus and doesnt make you ill...We dont have many choices, do we? There has not been any approved new meds for lupus in 20 years according to the LFA, ALR and more...That is UNACCEPTABLE!!!
Good luck to you, and keep us posted, OK?
Lauri

lcasnyder
07-17-2008, 12:53 PM
Okay guys here is what I know. I went for an appt. with primary physician today. Also saw my labs from the ER visit that weren't back yet. My lupus isn't quite like the Rheum. thought when I saw him. My C3, C4, and ds dna are all high. I also have mesenteric adenitis. The primary dr. was irritated when I told her that the Rheum. sent me to the ER and said that my Lupus was quiet and the ER doctor tells me that she thinks it is all Lupus related. She is also upset that they didn't try to find out why I have mesenteric adenitis. She said there is a cause and they should have ruled out if it is being caused by the lupus or not. She also complemented me on the fact that I had stopped the Placquenil. Especially since stopping I don't have the awful headaches I was experiencing, the abdominal bloating and cramping, my blood sugars have actually regulated now, and my head just seems clearer. She said I am just on of those people who can't take it.
We discussed a different Rheum. today and she is setting me up with one affiliated with Hershey Hospital if any of you live in PA. Her and I both agree that maybe with it being a teaching hospital and the younger doctors just coming in might be more insightful and willing to look into things more and give me more help and far as my lupus goes. She agrees that I need to see the new Rheum. as soon as possible so we can try and find something else to do for me to control the lupus. She is being really aggressive again, which I love because she listens. She is also sending my for an MRI of my brain and spine. She is curious about Cerebral Lupus. Just because of different symptoms and things that have been going on, put up a flag for her. She is very straight forward and persistent. I am at least in good hands with her.
My ? is do any of you have cerebral lupus or have mesenteric adenitis? Has anyone else had problems with the placquenil?
Thanks to all. Linda