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Nephrology/High Blood Pressure and Test Results

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Question
Hi Dr. Shah, I'm a 25 year old male, and was diagnose with high blood pressure about a year and a half ago.  I'm in excellent shape, exercise regularly and eat well.  My primary care physician sent me to a nephrologist to look into why this could be happening at such a young age.  My father and grandfather had high blood pressure before me, but they still wanted to investigate.  

I did some blood tests as well as a renal artery and a renal utltrasound.  The only thing that came back as irregular was there were small amount of blood in my urine.  I have had small bouts of prostatitis in the past, so they doctor thought that maybe the cause. She also noticed that my left kidney is slightly smaller than my right.  

I went back to the nephrologist about a year later (two weeks ago) and did some tests again.  I again had blood in my urine.  She also ordered complement C3 and C4 tests, lupus tests, and hepatitis tests.  Everything came back normal, except the complement tests were on the low side.  My complement C3 value was 77 with a refence range of 90-180, and my complement C4 value was 17 with a value of 16-47.  I found that other reference ranges for C3 are lower (70-160), but I am slightly concerned about the results due to the illnesses that low C3 and C4 can predict.

Do you think there is anything to be concerned about or could it be related to prostatitis or something else?  I haven't really had any other symptoms or anything such as swollen legs or face or painful joints.  One other point of interest is that my PCP requested that i measure my blood pressure on and off medication for the last month or so, and the values have been low enough when I haven't been on medication that my PCP said I can stop taking it entirely and to closely monitor my blood pressure.  Do you think that's a good idea?  

Thank you, I appreciate the time.

Answer
Brandon,

Thanks for asking my opinion on Allexperts.

The presence of red blood cells in the urine is one of the red flags for the presence of glomerular disease. If you were my patient, I would order a phase contrast microscopy to see if the RBCs in your urine are dysmorphic. If so, I'd discuss the pros and cons of doing a kidney biopsy with you.

The differential diagnoses would include IgA Nephropathy and Thin Basement Membrane Disease.

I don't see a problem with discontinuing your BP meds as long as you closely follow your blood pressure religiously.

Sincerely,

Dr. Shah

Nephrology

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Dr. Shamik Shah, MD, DNB (Nephrology), ISN Fellow

Expertise

I can answer all questions related to kidney diseases, hypertension, plasmapheresis and kidney transplantation. I am an Indian-Board certified Nephrologist. I was a post-Doctoral Scholar at the Division of Nephrology & Hypertension,Department of Medicine, University of California, San Diego. My area of interest is Critical care Nephrology and Acute Kidney Injury.

Please mention the units in which your lab results were reported and the normal reference range for your laboratory.


Alternative Website
http://www.syndeohealth.com/doctors/shamik-shah/91

Experience

Ten years as a Critical Care & Transplant Nephrologist

Organizations
International Society of Nephrology
Indian Society of Nephrology
Indian Medical Association
European Renal Association


Publications
- Shah SH, Cerda J. Acute Tubular Necrosis; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4, pp. 191-198
- Shah SH, Cerda J. Management of Acute Kidney Injury; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4
- Cerda J, Tolwani A, Shah SH, Ronco C. Continuous Renal Replacement Therapies in Modeling and Control of Dialysis Systems edited by Azar AT, Springer-Verlag, Heidelberg, Germany (In Press)
- Shah SH, Cerda J, Kellum JA. Acute Kidney Injury in Special Circumstances. John Kellum, Jorge Cerda, eds. Renal and Metabolic Disorders, Oxford University Press (In press)
- Shah SH, Mehta RL. “Anticoagulation in CRRT: Is Citrate better?”; Vineet Nayyar Ed. Critical Care Update 2009, Jaypee Brothers (In press)
- Shah SH, Mehta RL. “Non-dialytic management of acute kidney disease”; Evidence based Nephrology, BMJ, (In press)
- Shah SH, Mehta RL. “Epidemiology of Community-acquired AKI”; Ronco C, Bellomo R, Kellum J Eds. Critical Care Nephrology, Saunders. ISBN 1-4160-4252-0
- Abdeen O, Shah SH, Mehta RL; “Dialysis therapies in the surgical intensive care unit”; William Wilson, Christopher Grande, David Hoyt Eds. Trauma: Resuscitation, Anesthesia, and Critical Care, Informa Healthcare, NY 2007. ISBN 0-8247-2920-X
- Shah SH, Mehta RL. Acute kidney injury in critical care: time for a paradigm shift? Curr Opin Nephrol Hypertens. 2006 Nov;15(6):561-5.
- Shah, SH, Soroko S, Lischer E, Mehta RL. Delivered vs. Prescribed dose of Dialysis in Hospitalized Patients: Results of an Audit. J Am Soc Nephrol 17(Abstracts Issue): 2006, 107A.
- Shah SH et al “Biochemical Nutritional Parameters in Non-vegetarian and Vegetarian CAPD patients” Perit Dial Int 2001; 21 Suppl 2: S1-182


Education/Credentials
MBBS, MD (Internal Medicine), Diplomate of National board (Nephrology), ISN Fellow

Awards and Honors
Educational Ambassador of the International Society of Nephrology 2010
Fellowship of the International Society of Nephrology 2005.
Young Investigator Award by the International Society of Peritoneal Dialysis 2001

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