Metabolic Panel/Urinalysis

Just had a visit with my GI Dr last week. In a mild flare and have been on Uceris for 30 days-no improvement. Stopping Uceris-Discussed Entyvio (Prednisone no longer a option). He ran some lab test and the Metabolic Panel was completely normal however the Urinalysis was all over the board (was completely normal for annual physical in January 2021. He had tested my calprotectin in Dec 2021 and it was 200. Waiting on results for new calprotectin test.
Urinalysis results that were out of range:

Specific Gravity
Protein 2+
Ketones Trace
RBC 11-30
Crystals Calcium Oxalate

Seems like a lot going on-I will be calling Monday to see if maybe it was a defective test.

This was the first time to use Uceris. I have been on full dose of Lialda and Rowasa for years and take Bystolic for Hypertension (9 years).

Has anyone else had this happen with a Urinalysis??

Thanks

Old Hat

Thanks for the response. He did test for eGFR and it was 63. For 57 years i have been on sulfasalazine until changing to Lialda 9 years ago with flares handled by Prednisone . I do have my annual physical coming up next mother-in-law with my Primary Care Physician. Looked at last years urinalysis and everything was normal range.

"mother-in-law"-- LOL! Sounds good that you have upcoming apptmt with your PCP, who may decide to do another urinalysis. I'm sorry that your UC med is causing you continuing problems, and hope you'll be able to try Entyvio. (I had to stop using Rowasa ca. 2004 after 14 years because it turned against me during a flare-- felt like it was eating into my left side, yikes!) / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)

One more thing, for me... Calcium was a kidney stone, RBC was from the damage/struggle of kidney function/and that 5mm kidney stone, and protein was because my kidneys were struggling to filter. Thus diet changes and medicine changes.

A nephrologist really helps with this. A urologist was not as knowledgeable. (I want to 3 urologist and 2 nephrologists.) Urologist just didn't have the same knowledge base, 1st nephrologist was knowledgeable but no experience, and 2nd nephrologist had experience with IBD patients plus experience with kidney damage.

Make sure your doctors all work together. Realize that there may be a difference of opinion and you may have to utilize yet another doctor for a 3rd opinion and even then you will need to make your own decisions. My GI still grumbles about the 3 months off from Remicade and the fact that I am now struggling with antibodies and UC/Crohn's issues.

Thanks for the response. I have not seen anephrologist yet. Just got the Urinalysis posted on line in the patient portal at my GI website. Sent him a message Friday and hopefully will get a response in several days. My results sound similar to what you had. Looks like after 57 years the meds might be taking a toll on Kidneys. Just strange how last January all results were normal and now 4 or 5 are out of normal range. Thanks again.

clo2014 said...
One more thing, for me... Calcium was a kidney stone, RBC was from the damage/struggle of kidney function/and that 5mm kidney stone, and protein was because my kidneys were struggling to filter. Thus diet changes and medicine changes.

A nephrologist really helps with this. A urologist was not as knowledgeable. (I want to 3 urologist and 2 nephrologists.) Urologist just didn't have the same knowledge base, 1st nephrologist was knowledgeable but no experience, and 2nd nephrologist had experience with IBD patients plus experience with kidney damage.

Make sure your doctors all work together. Realize that there may be a difference of opinion and you may have to utilize yet another doctor for a 3rd opinion and even then you will need to make your own decisions. My GI still grumbles about the 3 months off from Remicade and the fact that I am now struggling with antibodies and UC/Crohn's issues.

Sounds like you have had to manage quit a bit. Great advice. I do have a really good urologist that understands UC and if I see him first I know he will recommend a good nephrologist.

The gastros used to order urinalysis, especially during 5-ASA use by UCers, but more recently they focus on eGF via blood labs. Also, health insurers mix into this process because some consider urinalysis to be a PCP's domain and don't want to reimburse specialist practitioners for ordering it routinely. Cost containment is a huge part of medical practice that we all need to be aware of these days ... alas! / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)

First thing is to repeat the urinalysis. Cheap and easy. You were probably fasting and withholding liquids if the blood panel was done at the same time. Hydrate.

Egfr or egf is the filtration rate for your kidneys. This rate can indicate filtration issues for patients taking IBD medications--some of which are nephrotoxic. If your numbers are consistently low it can indicate kidney issues. The Egfr rates lower than 60 can indicate kidney damage/disease or even filtration issues (think dehydration, obstruction or even severe UTIs) This is not the only test utilized to determine kidney damage/kidney disease. Once a consistently low Egfr is established your doctor usually recommends urinalysis, urology scopes, CT scans and sonograms to determine if tests indicate there really is an issue and to determine if kidney disease or damage has occurred while establishing cause. Sometimes diagnosis is made by ruling things out.

From what I have been told, a urologist makes sure everything (mostly the urinary tract....bladder, kidneys, etc.) is "working" (looking for obstructions, infections)while a nephrologist concentrates on the kidneys and what could cause them not to work correctly such as diseases, diabetes, nephrotoxins. In my experience the nephrologist is called in when either the urologist can not determine a cause or there is a case of acute or sudden renal failure.

My GI has tested my Egfr since day 1. He stated that medications can cause issues to IBD patient kidneys. In his opinion IBD patients seem more prone to issues than the general population. I have not had an issue with my insurance paying for those tests yet. (Knock on wood)

Whenever I have an abnormal test result we immediately do another test. There have been many test results that came back fine on the 2nd test. And finally....when you are having any tests done make sure you are really hydrated. If you are even alittle dehydrated you can get incorrect or exaggerated results.

Clo

My GI Dr has already called this morning. Since I have my annual Physical in 2 weeks will retest urine. Also calprotectin test has gone from 200 to 1000+ in 4 weeks. Can't handle steroids again (Last time started at 60mg and took 9 months to get under control-don't think my body can handle anymore pred after 57 years of this disease and 2 neck fusions). We discussed Entyvio. He is ordering the test needed before starting Entyvio.

How close do you need to be on the Entyvio schedule exactly to the day are can you vary by several days?

Is this covered by Medicare Part B?

Thanks

straydog said...
Entyvio should be covered under Medicare since it's an infused drug. Once you do the three loading doses, you will have an infusion every 8 weeks. You want to do your infusions on the recommended scheduling so the drug stays at it's optimal level. Sure once in a while something can happen to throw things off, but it's best to stay on schedule the best you can.

Good luck with all of your tests. Wow, two neck fusions & prednisone, that's a bad combination long term. I hope you have been having scans to check for osteoporosis.

Take care.

Yes a lot of Prednisone since the 70's. That was the main drug to get a flare under control for me when the Sulfasalizine couldn't maintain remission. I do get scans for osteoporosis. Just can't handle the side effects of Pred anymore. Was between Remicade and Entyvio and opted for Entyvio. Now just waiting for testing to see if it is a go.

Entyvio is covered 80% under Medicare part b since it’s administered by a director/hospital setting. Hopefully you have a supplement to cover the remaining 20%. They bill Medicare something like $16k for my infusion. Medicare pays about $5k and my supplemental pays another $2k.

My orders allow a week either way to adjust my 8 week schedule. Only twice in 5 years have I had to adjust my scheduling — I think I opted to go early both times rather than go more than the 8 weeks. I’m very happy with Entyvio.

FlowersGal said...
Entyvio is covered 80% under Medicare part b since it’s administered by a director/hospital setting. Hopefully you have a supplement to cover the remaining 20%. They bill Medicare something like $16k for my infusion. Medicare pays about $5k and my supplemental pays another $2k.

My orders allow a week either way to adjust my 8 week schedule. Only twice in 5 years have I had to adjust my scheduling — I think I opted to go early both times rather than go more than the 8 weeks. I’m very happy with Entyvio.

Glad Entyvio has worked well for you. If all goes well should be starting in about 6 or 7 weeks. Thanks so much for your help and support.