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Causes and risks of kidney stones
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Causes and risks of kidney stones

I’m a 35 year old female with numerous kidney stones in both kidneys, which were first discovered 5 years ago when I was pregnant.  I saw a urologist recommended no treatment since they were all small stones.

I had no symptoms from the stones over the last 5 years.  Then during my last pregnancy, I began having blood visible in my urine and discovered that there were still stones in both kidneys, but they were now much larger.  

I had PNL to remove stones from my right kidney.  I opted for the surgery rather than ESWL because my urologist said that due to the number and size of the stones, it was likely that it would take multiple ESWL treatments to get rid of all the stones.    My urologist was able to remove many of the stones, but there were many other that were in the “meaty” part of my kidney and he was unable to get to them.    

I’ve had several stones analyzed and they have all come back as 90% Carbonite apatite and 10% Calcium oxalate.   My urologist has ordered a 24 hour urine collection and sent the stones collected during the surgery to be analyzed.  He has theorized that I’m making stones because of infection in the kidney (I have a history of chronic UTI’s, but all of my cultures in the last year have come back negative), a condition like RTA, or my kidneys began hyperfiltrating due to pregnancy.    Do these causes sound reasonable?  What other tests should I be asking for?  How unusual is it for the stones to be in this meaty part of my kidney and since they are still in my kidney aren’t they just going to continue to grow larger?    Are these stones causing damage to my kidneys?  They don’t seem to be causing any blockages based on the ultrasounds that have been done, but I still have had frequent flank pain and blood visible in my urine prior to the surgery.  Is there any hope that I will be able to be stone free and prevent more stones?    
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I am not sure that I understand the infection or hyperfiltration theories  in your case but  the rest is plausible. I would  ask  your urologist to evaluate you for RTA (renal tubular acidosis)  which will require some blood work. Actually a stone workup involves both blood and  urine tests. The  blood at least for: uric acid, electrolytes( sodium, potassium, chloride, hco2), creatinine, phosphorus, calcium and the urine at least for: uric acid, magnesium, calcium, citrate, oxalate, creatinine and sodium.
I would suggest a yearly x-ray of your abdomen (not a CAT scan)  to observe any remaining stones for growth. The blood in your urine may occur from time to time because of the existence of the stones,  If you have not had a cystoscopy to look for causes of blood in your urine from something other than stones, then I would recommend a cystoscopy.
Stones that are not causing obstruction  and are not infected should not be causing pain.  I think that those episodes of pain and hematuria are likely related to the passage of small stones.
Can you be rendered stone free? I cannot tell. In part this answer would be related to the cause of your stones.    Certainly, I think that we can find medication and/or diet to decrease the recurrence rate of stones and keep any that are in your kidneys from growing.
Hope this helps.
S.A.Liroff, M.D.
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Just adding more detail to my initial question.  I received my surgery report and it states that the remaining stones are in the intraparenchymal region of the kidney.   It also states that the upper most calix, middle calices and the lower calix all have intraparenchymal stones and Randall plaques.  But, the Randall plaques were removed.  
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