Blood Tests, KUB Ultrasound and ECG for November 2011

I went for my schedule medical checkup at the University Malaya Medical Centre Spinal Rehabilitation Clinic on Wednesday. The good news is that the renal and liver profiles did not show significant changes. Serum creatinine has gone down to 272 umol/L from 291 umol/L in July 2011.

Renal profile for November 18, 2011

Sodium 139 mmol/L
Potassium 4.8 mmol/L
Chloride 105 mmol/L
Total CO2 26.0 mmol/L
Anion Gap 13 mmol/L
Urea 7.8 mmol/L
Creatinine 272 umol/L

Liver profile for November 18, 2011

Total Protein 76 g/L
Albumin 38 g/L
Globulin 37 g/L
Total Bilirubin 8 umol/L
Conjugated Bilirubin 2 umol/L
Alk Phosphatase 86 IU/L
Gamma GT 12 IU/L

The cholesterol levels are not too encouraging though, especially when there is a history of heart problem in the family. My father passed away from congestive heart failure. I was advised to go on the lowest dosage of Lipitor (atorvastatin calcium) which is 10mg to keep the cholesterol levels in check.

Lipid profile for November 18, 2011

Triglyceride 1.4 mmol/L
Total cholesterol 4.7 mmol/L
HDL 0.97 mmol/L
LDL 3.09 mmol/L

The ultrasound of the kidneys, ureters and bladder report is somewhat similar although the length of the left kidney size was measured at 8.9cm this time as compared to 9.1cm in December 2010 and 6.89cm in February 2004. There is an inconsistence in the three reports, with the 2010 report being the odd one regarding size of both kidneys and the position of the cyst.

KUB Ultrasound Report for November 18, 2011


Comparisons made previous ultrasound dated 27.12.10
Both kidneys are normal in size but with increased echogenicity
The right kidney measures 9.5cm in BPL and 0.6cm in cortical thickness
The left kidney measures 8.9cm in BPL and 0.5cm in cortical thickness
There is a small cyst seen in the upper pole of the left kidney measuring 1.0cm
The bladder wall is trabeculated
Prostate is normal in size with smooth outline

Renal parenchymal disease
Left renal cyst
Trabeculated bladder secondary to neurogenic bladder

Electrocardiograph (ECG) for November 30, 2011
Electrocardiograph (ECG) for November 30, 2011.
Photo by Wuan with Samsung Galaxy S II.

I also had an electrocardiogram (ECG) done on the same day as the checkup. According to the doctors, the results did not show any problem which is a relief.

ECG figures for November 20, 2011

Rate 88

PR 152
QT 380
QTC 460

P 62
QRS 90
T 67

Overall, I am happy with the blood test results except for my cholesterol levels. Renal and liver profile tests will be done two months after I have started on Lipitor to check whether these organs are effected by it. A urodynamics study is also scheduled in the first quarter of next year to determine the pressure in my bladder. It was last done in 2008 at Subang Jaya Medical Centre.

Urinary Tract Infection

Early Sunday morning, I woke up shivering. It was not the air conditioner. I knew what it was as I had sort of anticipated it. Chills are the first and unmistakable sign of a urinary tract infection (UTI). It was around 4.00am then. I know for sure because I turned on the television to watch the AXN channel.

I must have caught it during the urodynamics study. It is not an uncommon occurrence after this procedure. No matter how sterile the gears were, somehow somewhere during the process, something was bound to be contaminated and the contaminant introduced into my urinary tract.

In the afternoon, I took two Panadol Actifast tablets and the fever or chills has not recurred since. My urine has been cloudy for the past two mornings though. It clears up as the day progresses. I have been drinking water a lot to flush out whatever that is still inside. I have also been drinking cranberry juice.

I know I should be seeing a doctor for this. UTI in people with kidney disease is no small matter. The infection may just wipe out the little that is left of the renal function that I still have. Tomorrow. I will make it a point to see a doctor if the urine is still cloudy tomorrow. For now, all I want to do is to lie down and go back to sleep.

First Urodynamics Study

For all the years that I have been living with spinal cord and chronic renal failure, I have not had a urodynamics study done to determine the pressure in my bladder. This test is needed to determine whether the pressure in the bladder will cause a reflux and further damage to the kidneys.

I had one done at SJMC last Saturday for once and for all as to see if the pressure in my bladder is the cause of my renal failure and whether I need further treatment. I have been waiting to get it done at UMMC but two appointments were cancelled. The first time was because the urologist was away and the second because the urodynamics clinic was under renovation.

All garbed up at SJMC waiting for the urodynamics study to commence
All garbed up at SJMC waiting for the urodynamics study to commence.
Photo by Wuan.

There is usually a six-month waiting period at UMMC but it would have been done free of charge there as I hold the Kad Orang Kurang Upaya from the Department of Social Welfare Malaysia. It costs RM1,500 at SJMC. Another urodynamics study was schduled for mid-June at UMMC but I thought I better get it done first at SJMC just in case the one at UMMC gets cancelled again.

The procedure was not as embarrassing as I had anticipated. The technician was very patient in explaining the entire procedure and made me feel at ease even though I was bare-bottomed throughout. A thin tube was inserted through the urethra into the bladder and another into the rectum. The tubes were connected to a device that fills up the bladder with saline at a pre-determined rates – 30ml/min and 15ml/min, measured the pressure in the bladder as it filled up until urine started to leak.

The equipment used for the urodynamics study
The equipment used for the urodynamics study.
Photo by Wuan.

Another device was placed right below my seat to measure the amount of urine that leaked. After that, the residual urine in the bladder was sucked out with a syringe and measured. The results showed that the presurre in my bladder is normal until the volume is around 300ml where the pressure rises to slightly more than 50cmH2O and the fluid started to leak. The leaked volume was around 100ml while residual volume was around 200ml.

According to the urologist, as long as I keep up with my three hourly intermittent catheterisation programme, it should not be a cause for concern as reflected by the results. No further treatment or medication is necessary. He recommended that I get the urodynamics study done every two years. He also checked the lump in my scrotum which has gotten smaller after a two-week course of antibiotics. I am to go back to see him in two months to get the lump checked again.