Letter no. 2:
Dear Mrs K.
You suffer from sudden pallors and coolings of your fingers, sometimes also of your toes. Sometimes your urine
is discolored brownishly, sometimes reddish. You suspect that these discolorations of your urine are caused by additions of blood. Now you ask, whether these symptoms require a medical treatment or are harmless. You
write to us that you are afraid of visiting your physician. So you would like to take advice from us on this way.
Naturally it isn't possible to make diagnoses "from the distance". However, we can give you
some general advices. Perhaps our informations are suitable to reduce your fear of a physician visit.
Pallors of fingers and toes can be caused by temporary circulatory disorders. Such circulatory disorders can be
caused by temporary vasospasms of the blood vessels in the fingers or toes. This phenomenon is called "Raynaud syndrome". This Raynaud syndrome can be harmless. It can be caused by various drugs (for example
ergotamine, beta blockers, contraceptives). This syndrome also can point to some rare illnesses being called "collagenoses".
Discolorations of the urine not always have to indicate that there is blood in the
urine. The color of the urine can be very different depending on drinking quantity, nutrition composition and metabolic situation. So discolorations of the urine can have many different causes.
A simple laboratory
examination of the urine canshow, whether there is actually blood in the urine or not.
If blood is actually found in the urine, it must be investigated by additional examinations whether there is a pathological cause.
Ultrasonic examinations of kidneys and urinary bladder are suitable for this, furthermore a X-ray examination of the urinary organs (intravenous urography). An endoscopy of the urinary bladder (cystoscopy) can
supplementally be necessary in addition. An urinary tract infection also should be excluded by urine examinations. An urinary tract infection also can cause blood in the urine and does not always affect the urination.
On the other hand a Raynaud syndrome combined with blood in the urine also could point to a relatively rare collagenosis (systemic lupus erythematosus). This disease can damage different organs, also the kidneys. On the
other hand this disease is very rare and it is normally characterized by several additional symptoms which aren't indicated by you.
A capillary microscopy (capillaroscopy, microangioscopy) as an additional
examination can be discussed with regard to angiology. The capillaries are examined microscopically at this examination in the nail fold of the fingers. These capillaries can already show typical morphological
alterations in very early phases of those rare collagenoses.
Moreover some special blood tests have to be be carried out to diagnose these diseases.
Reddish or brownish discolorations of the urine also can rarely be
caused by certain metabolic diseases (porphyrias). These illnesses can be diagnosed by special laboratory examinations. On the other hand porphyrias are usually characterized by other additional symptoms which are not
described by you.
All aforementioned examinations are painless and harmless with the exception of the cystoscopy, which may be unpleasant. A cystoscopy, however, need not be carried out in every case. If these
examinations do not have any pathological results, serious diseases should be rather improbable.
Since the symptoms stated by you can have many different causes you should consult your physician as soon as
We hope very much that our information are helpful for you.
Jörg Piper, MD, Senior consultant