Hematuria - #9740

Hi Fida, the persistent blood in your urine (hematuria) following high-dose vitamin D supplementation could be linked to vitamin D toxicity, which may lead to hypercalcemia (elevated calcium levels in the blood). This condition can cause kidney-related issues, including the formation of kidney stones, which are known to cause hematuria. Although your ultrasound and other tests haven’t revealed significant abnormalities, it’s important to consider that vitamin D toxicity can result in hypercalciuria (excess calcium in the urine), potentially leading to kidney stones and subsequent hematuria. This condition is often associated with excessive vitamin D intake. Recommended Actions: 1. Discontinue High-Dose Vitamin D Supplements: Stop taking any high-dose vitamin D supplements immediately. 2. Consult a Healthcare Provider: Seek medical advice to evaluate your kidney function and calcium levels. 3. Monitor Symptoms: Keep track of any new or worsening symptoms and report them to your healthcare provider promptly. It’s crucial to address this issue promptly to prevent potential complications.

Thank you for consulting Fida,Here's a step-by-step solution plan for your persistent hematuria (blood in urine), especially considering the vitamin D overdose history and normal ultrasound: Step 1: Reassess Labs Ask your doctor to check or review the following: Serum Calcium and Creatinine – to rule out effects of Vitamin D overdose. Urine Calcium (24-hour collection) – excess calcium can irritate kidneys or form stones. Urine Microscopy – to see if red blood cells are dysmorphic (suggests kidney origin) or normal (suggests bladder or urethral source). Urine Protein – presence of protein can suggest glomerular disease. Urine Culture – to rule out low-grade infection. eGFR – to check your kidney function. Step 2: Imaging and Endoscopy If not already done: Repeat Ultrasound of kidney, ureters, and bladder (KUB), ideally with doppler. If hematuria still persists. Step 3: Monitor and Adjust Lifestyle Stop or reduce all vitamin D supplements unless prescribed by your doctor after current blood test. Drink 2.5 to 3 liters of water per day to flush kidneys. Avoid foods high in oxalate (spinach, beetroot, chocolate) if calcium is high. Avoid unnecessary NSAIDs or painkillers – they can irritate kidneys. Step 4: Long-term Follow-up If all tests are normal and hematuria is still present, but kidney function is fine and there’s no protein loss, your doctor may consider: Benign Familial Hematuria Idiopathic Hematuria (no cause found) These often don’t need treatment but should be monitored annually. Thank you. BE STRONG AND HEALTHY.

Hi fida Relax it’s your Dr Shayeque Reza **Outpatient Department – **Patient Name:** Fida Hussain **Age/Sex:** 31 / Male **Date:** 12-04-2025 **Chronic Illnesses:** None **Other Observations:** Dark skin patches (suggestive of metabolic or endocrine correlation) C/O **Chief Complaints:** 1. Hematuria (blood in urine) for the past 1 year 2. No associated dysuria, fever, flank pain, or systemic symptoms 3. History of Vitamin D deficiency treated with nano shots (patient self-reported overdose) 4. Hematuria noticed after initiation of Vitamin D therapy 5. Ultrasound and routine blood tests have shown no significant abnormality --- ### **Provisional Diagnosis:** - Persistent idiopathic hematuria - Rule out glomerular source (microscopic hematuria with dysmorphic RBCs) - Possibility of nephrocalcinosis or subclinical renal insult due to high-dose Vitamin D - Acanthosis nigricans or insulin resistance-related skin changes (dermatological evaluation advised) **Suggested Investigations:** 1. Urine Routine and Microscopy (3 consecutive early morning samples) 2. Urine RBC Morphology (to differentiate glomerular vs. non-glomerular origin) 3. Urine Culture and Sensitivity 4. Serum Urea, Creatinine, Electrolytes 5. Spot Urine Protein/Creatinine Ratio or 24-hour Urine Protein 6. Urine Calcium/Creatinine Ratio 7. CT Urogram or IVP – if symptoms persist and diagnosis remains unclear **Management Plan:** - Avoid further high-dose Vitamin D supplementation unless medically supervised - Encourage hydration (2.5 to 3 liters of water per day) - Monitor for new symptoms: pain, fever, weight loss, or worsening hematuria - Maintain symptom diary to observe any activity or diet-related variation in hematuria. **Follow-Up:** - Review after 2 to 4 weeks with investigation reports - Sooner if new symptoms develop or hematuria worsens. Dr Shayeque Reza MD 9800280276 Do give your review.

Hello With regards to your concern, Get vitamin d levels tested Increase your fluid intake Get Renal function tests done. If hematuria still persists bladder wash has to be done.