<s>[INST] Hi: (See Labs below) In your opinion, do I have a kidney infection? I have a history of kidney infections. 2-3 per year for the last 40+ years. My kidneys have been bugging me and, between early December 2013 to l0 July 2014, saw my doctor & had labs done 4 times. 7-8 months and several phone calls and emails later, he sent me an email saying Most recent U/A was negative for infection . I went online to scheck my labs. All lab results since Dec 2013 are about the same as the last ones (Shown below) except for the following : each eGFR lower than previous, starting at 59.9 in Dec 2013 dropping to 41.3 in Jul 2014; Bun was 20 now 30; Creatinine went up from .96 to 1.32; Bacteria went from few(2-5) to Many( 15) and Protein increased from none to 30. UA RESULTS (Clean catch/mid-stream):      Test Name       Result       Units       Reference Range            AMORPHOUS SEDIMENT.................. None.......................................................................................                 APPEARANCE......................................... CLEAR...................................................................................                      BACTERIA.................................................MANY( 15) High......per hpf................0-1            BILIRUBIN................................................NEG..........................................................NEG            CALCIUM OXALATE CRYSTALS......Norm(0-1)...................per hpf.................0-1      COLOR........................................................YELLOW...............................................................................                     EPITHELIAL CELLS...............................FEW(2-5)....................per hpf..................0-1            EPITHELIAL CELLS.RENAL...............None...........................per hpf..................None            ERYTHROCYTES....................................Norm(0-3)...................per hpf..................0-3            GLUCOSE..................................................NEG.............................mg/dL....................NEG            GRANULAR CASTS...............................None.............................per lpf...................None            HEMOGLOBIN........................................TRACE........................................................NEG            HYALINE CASTS....................................MANY( 15).................per lpf....................0-1            KETONES.................................................NEG..............................mg/dL....................NEG            LEUKOCYTE ESTERASE....................TRACE.........................Leu/uL..................NEG            LEUKOCYTES.........................................Norm(0-5).....................per hpf..................0-5            MIXED CELLULAR CASTS.................None............................per lpf....................None            MUCUS.......................................................present............................................................................................                      NITRITE.....................................................NEG.............................................................NEG            PH.................................................................6.5..................................................................5.0-8.0            PROTEIN....................................................30..................................mg/dL....................NEG/TRACE            SERVICE COMMENT 01........................YES, Urine Leukocyte Esterase and/or Nitrite positive.                      SPECIFIC GRAVITY...............................1.020...............................................................1.003-1.035            TRANSITIONAL CELLS........................None..............................per hpf..................None            TRICHOMONAS VAGINALIS..............None..............................per hpf..................lNone            TRIPLE PHOSPHATE CRYSTALS......Norm(0-1).....................per hpf..................0-1            URIC ACID CRYSTALS, UR..................Norm(0-1).....................per hpf..................0-1            UROBILINOGEN......................................0.2..................................mg/dL....................0.2-1.0            YEAST...........................................................None.............................per hpf..................None PLASMA BLOOD RESULTS (Non-fasting/Had coffee latte with whipped cream & glazed donut @ one (1) hr before test):      Test Name       Result       Units       Reference Range      CALCIUM......................................................................................9.83...................mg/dL.........8.7-10.2      CARBON DIOXIDE...................................................................32......................mmol/L........23-33      CHLORIDE...................................................................................98......................mmol/L........98-106      CREATININE...............................................................................1.32 High........mg/dL...........0.5-1.1      GLOMERULAR FILTRATION RATE.PREDICTED........41.3 Low.........mL/min.......... 60      GLUCOSE.....................................................................................73 Low.............mg/dL...........74-118      POTASSIUM.................................................................................3.5....................mmol/L.........3.4-4.8      SODIUM.........................................................................................139...................mmol/L.........136-144      UREA NITROGEN......................................................................30 High...........mg/dL...........8-26 Thanks -Barbie [/INST] Dear Patient,your exams are diagnostic for bacteriuria. However, if you don't have fever, I cannot define it as an infection. However, I see that your kidney function is not going very well, since creatinine and GFR are abnormal. Do you take NSAIDS or any nephrotoxic drug? If yes, hold it. Moreover, your urine sediment is not active, thus I would exclude an active GN. Do you have hypertension? I would suggest: 1) renal scintigraphy in order to exclude scars  I of previous pyelonephritis; 2) exclude an urinary reflux; 3) consider a renal biopsy, if kidney size and parenchyma are still ok. </s>