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Questions posted in the
The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.
Question Title: Calcium deposits or UPJ Obstruction?Forum: The Urology Forum
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In April of last year I was diagonised with a kidney stone. I did not pass it on my own so my Uro. manipulated it and a few days later I passed it. I then passed another within a week. I still had alot of pain so my Uro. ordered a IVP. another stone was found. My Uro. was going to manipulate it a few weeks later but could not find it on a KUB so he ordered another IVP. No stone was found. The IVP did show delayed clearance of the contrast and hydronephrosis. I still had alot of pain so he ordered a hecial scan. No stone found, but alot of scarring in the renal pelvis. My Uro. thought I might have UPJ Obstruction since my pain usually comes on after drinking fluids. He ordered a lasix renal scan, that showed no obstruction but did show my kidney function is 75L-25R.This was all done by mid August. I still was having alot of pain,numerous UTI,(been on antibotics pretty much straight since April,sometimes for up to 8 weeks at a time. I go off of them and within a week or two back on antobotics.)I always have hemituria, sometimes white cells. In October he did another IVP, It showed the same thing, delayed clearance and hydronephrosis, but no stones. He had me have a gallbladder scan done and a liver test to rule that out. Those were Neg. In Dec. he decided to put a stent in me. He wanted to leave it in for 6-9 months to heal open the kidney pelvis. He had to remove it after 4 wks. because of stent irriation. (Gross hemituria and frequency) When the stent was in I did not have the pain from drinking fluids anymore, just the discomfort from the stent. He also diliated my kidney pelvis when he removed the stent. The pain has come back again, within a few days of the stent removal. I did have the pain also the last few days I had the stent. I told my Uro. before he removed the stent, he said he would see if anything was blocking it when he removed it. He said their was sediments blocking the stent. I also notice sometimes when I use the bathroom it is very cloudly almost looks like milk and sometimes sandy stuff. I mentioned this to my Uro. but he does not seem to concern about it. I just seen my Uro. last week, I am on antibotics again, keflex 4x a day for 3 wks. and then once a day for 1 wk. I just went of of antibotics about 10 days ago. I am wondering if possibly my kidney is intermittently blocking with calcium deposits not yet formed into stones and thats whats causing this. I had numerous kidney infections and stones about 15 yrs ago. My Uro back then cleaned out my kidney and I have not had any problems since. My kidney function then was 60L-40R. Does it sound like a pyeloplasty will help me at all? I am kind of nervous about it since nothing has proven UPJ obstruction for certian. I don't however want to lose any more function in my kidney. How much function do you have to lose usually before they remove it? I am getting tired of living like this for the past 10 months, I am only 35 and sometimes I feel 70. Also I don't sleep well at night after about 4-5 hrs. I wake up with a back ache and kidney pressure. Any suggestions or ideas would be helpful. Thanks.
Dear Debbie, thanks for your question. In summary you seem to be having a) multiple renal calculi, b) recurrent urinary tract infections, c) pain and discomfort in the loin and d) dilated pelvicalyceal system on an IVP (which is unobstructed on diuretic renogram (lasix scan). Have you ever been investigated for vesico-ureteric reflux? Some times your clinical presentation could be due to back flow of urine into the kidney. This may predispose for urinary tract infections and some discomfort. We however should not guess too much without actually looking at your x-rays. You should however not embark on pyeloplasty without objective evidence of obstruction. It It is also unlikely that your are developing recurrent obstructions due to crystals (very rare). You definitely should be under care of an adult urologist who can put together all the pieces of this puzzle for you. Hope this information will be of some help to you. This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. The Henry Ford Hospital Department of Urology has experience in the evaluation and treatments of problems such as you describe. We would be most interested in helping you. You can reach us through our toll-free number 1-800-653-6568. We can also arrange local accommodations through this number if this is your need. Please bring any x-rays [and pathology slides] (not just the reports) as well as any physicians' notes and lab test results that you may be able to obtain. These will help us greatly. Sincerely,
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