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Urology (Expert Forum)
Chronic Back Pain/Kidney Infection/Stones
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Chronic Back Pain/Kidney Infection/Stones
by Lorie Stermer, Nov 07, 1999 12:00AM
I am a 36 year old female. I have had approximately 11 kidney stones and currently have a stone in each of my kidneys. I experience chronic back pain on my left side. I often experience nausea. I have had several kidney infections. Whenever I have a virus it seems to settle in my left kidney.
I have been very frustrated as I feel that doctors do not take my problem seriously. I am treated when I have stones. I have had many IVP's when trying to pass stones and have had lithotripsy (spelling?) and am currently scheduled for another bout of lithotripsy.
I feel as if this is controlling my life. My doctor says my current stones are non obstructing calculi and should not be causing me pain. One stone I previously passed was examined and found to be calcium oxalate/phosphate. I have had blood tests and a 24 hour urine test done. These test showed nothing abnormal except for low urine output (which the doctor made me feel guilty for, as if I was holding back or something). I was recently told I have medullary sponge kidney on both kidneys.
Upon making my frustration clear at my latest doctors appointment, my "specialist" told me he would not "spoon feed me through this", that I should go and research it myself if I was not happy. I find many of the internet sites hard to interpret and full of medical jargon..How can I be expected to understand all of that?
I have come across a mention of a possible treatment for medullary sponge kidney. Thiazide diuretics are mentioned to effectively prevent stone formation. What are your comments on this medication. Are their side effects? Should my doctor be taking a more agressive approach to my problem or am I jus bein a baby as his back handed comment about "spoon feeding" me seems to indicate.
You comments would be greatly appreciated
I have been very frustrated as I feel that doctors do not take my problem seriously. I am treated when I have stones. I have had many IVP's when trying to pass stones and have had lithotripsy (spelling?) and am currently scheduled for another bout of lithotripsy.
I feel as if this is controlling my life. My doctor says my current stones are non obstructing calculi and should not be causing me pain. One stone I previously passed was examined and found to be calcium oxalate/phosphate. I have had blood tests and a 24 hour urine test done. These test showed nothing abnormal except for low urine output (which the doctor made me feel guilty for, as if I was holding back or something). I was recently told I have medullary sponge kidney on both kidneys.
Upon making my frustration clear at my latest doctors appointment, my "specialist" told me he would not "spoon feed me through this", that I should go and research it myself if I was not happy. I find many of the internet sites hard to interpret and full of medical jargon..How can I be expected to understand all of that?
I have come across a mention of a possible treatment for medullary sponge kidney. Thiazide diuretics are mentioned to effectively prevent stone formation. What are your comments on this medication. Are their side effects? Should my doctor be taking a more agressive approach to my problem or am I jus bein a baby as his back handed comment about "spoon feeding" me seems to indicate.
You comments would be greatly appreciated
Doctor's Answer
by hfhs M.D.-AK, Nov 22, 1999 12:00AM
Dear Lorie,
I think it is important for your to understand what is happening with your body, and it is both the physician and the patients responsibility to ensure that understanding is achieved. Medullary Sponge Kidney (MSK) has less than 5% of patients with poor long-term outcomes, although they due have painful stone episodes(renal colic) . Usually with hydration and proper medical therapy, many stones can be avoided. It is not unreasonable to postpone treatment of existing stones, because often the calcifications are still in the collecting ducts ( not the renal pelvis) where the stones may never cause a problem.
It is usually the sequella of medullary sponge kidney that require management (stones and infection). Many patients have hypercalciuria and are treated with thiazide diurectics to limit stone formation. If thiazides cannot be used, inorganic phosphates may be appropriate, if no infections are present. For patients with renal stones, thiazides should be given even if they do not have hypercalciuria. Some studies show that these medications arrest the development of nephrolithiasis (stone formation). However, thiazides often cannot be taken for long periods of time because the mechanism of action eventually leads to higher levels of calcium in the blood. Thiazides work by increasing the absorption of calcium in the kidney. Inorganic phosphates, block absorption of calcium from the bowels. They both decrease the amount of calcium in the urine.
Because infections are not unusual, cultures should be periodically sent. Coagulase-positive staphlococci are most common and should be treated even if cultures are less than 100,000.
Overall, your best mode of therapy is to drink plenty of fluids. If necessary, a thiazide diuretic can be started. Good Luck!
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Medullary Sponge Kidney
I think it is important for your to understand what is happening with your body, and it is both the physician and the patients responsibility to ensure that understanding is achieved. Medullary Sponge Kidney (MSK) has less than 5% of patients with poor long-term outcomes, although they due have painful stone episodes(renal colic) . Usually with hydration and proper medical therapy, many stones can be avoided. It is not unreasonable to postpone treatment of existing stones, because often the calcifications are still in the collecting ducts ( not the renal pelvis) where the stones may never cause a problem.
It is usually the sequella of medullary sponge kidney that require management (stones and infection). Many patients have hypercalciuria and are treated with thiazide diurectics to limit stone formation. If thiazides cannot be used, inorganic phosphates may be appropriate, if no infections are present. For patients with renal stones, thiazides should be given even if they do not have hypercalciuria. Some studies show that these medications arrest the development of nephrolithiasis (stone formation). However, thiazides often cannot be taken for long periods of time because the mechanism of action eventually leads to higher levels of calcium in the blood. Thiazides work by increasing the absorption of calcium in the kidney. Inorganic phosphates, block absorption of calcium from the bowels. They both decrease the amount of calcium in the urine.
Because infections are not unusual, cultures should be periodically sent. Coagulase-positive staphlococci are most common and should be treated even if cultures are less than 100,000.
Overall, your best mode of therapy is to drink plenty of fluids. If necessary, a thiazide diuretic can be started. Good Luck!
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Medullary Sponge Kidney
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As soon as I take the thiazide and release all of the fluid, my back stops hurting.
What could this mean?