Q: My daughter, 7 years old, has been found to have higher than normal counts of RBC in her urine. She looks healthy and doesn't feel any pain or sickness. Her creatinine level too is fine and all other tests are normal. No protein was found in her urine. What could be the cause of the high RBC levels in her urine? Could it be related to the fact that I have membranoproliferative glomerulonephritis (MPGN) myself? Is renal biospy to be done immediately? Our nephrologist has decided to delay the biopsy as the last creatine level was still low. When should renal biopsy be done on her?

A:After an Ultrasonography and Plain X-ray have excluded any abnormality, an important test on urine is to ascertain the origin of RBCs. Pathologist can differentiate blood cells coming from kidneys from RBCs originating in the lower tract, that is bladder using microscoppy. Next, the proteins in the urine are usually tested in a 24 hour collection, or a protein creatinine ratio is done on a spot urine sample. If RBCs seem to originate from the kidneys without any structural abnormality on imaging studies, renal biopsy is imperative to find out the cause and prognosticate the significance of the urinary finding.