Recurring formation of kidney stones for last 15 years.

[Dr-Nagdev]

Posted by Dr Nagdev on June 03, 1999 at 13:03:59
My patient is a male 32 years old has been suffering from formation of recurring kidney stones. The stones are posative for calcium, oxalates, and phosphates. He has also got parathyroid Harmone PTH done which is normal. Even sonography of the parathyroid shows nomal. He has also got 24 hours urine test done which is normal. He has also done a blood test for S.calcium, Phosphorous, Phosphates, Alkaline , albumin and S.creatinine all are in normal range. His Skull Lateral & Both metacarparalals Pa view x-rays are done and are within normal limits. Frequently (every nine months to twelve months). He forms a set (six to eight in number)of kidney stones which are excreted.Present ultra sound report shows 8 stones 2 in left and 5 in right renal calyceal all of a size of 6mm, and one in right mid ureteric calculas is present.Last year he was prescribed Zyloric 100 mg thrice a day for one month. But no change. He is a vegetarian loves dairy products, presently restricted and cut down on dairy product , tomatoes,and spinich. Family history of father having a single episode of renal calculi and sisiter witha renal calculi problem. I would like to know how to manage such recurring formation and any references to case studies.

Posted by HFHS M.D.-MS on June 07, 1999 at 08:04:28

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Thank you Dr. Nagdev for your complex patient.
I am not sure if you have performed all of these following test but I will mention them for completeness sake. Your patient needs a  24 hour urine while on a typical diet and fluid consumption. This urine should be sent for  volume ( most important and should be greater than 2000cc/day) , sulfates,  sodium, pH, calcium, phosphorous, oxalate, uric acid, cystiene, citrate and  magnesium. A urine should also be sent for  urine culture. These test should be reassessed once treatment has begun to confirm adequate response. An initial serum for uric acid, phosphorous, creatinine, bicarbonate, sodium, potassium, calcium, phosphorus, PTH and  magnesium. If there are any abnormalities   ( deficiencies  of inhibitors or excesses in promoters) , these should be addressed. He does have the  risk factor for a high oxalate vegetarian diet but this should be reflected in his 24 hour urine. A review of his medications, vitamins, past medical history and a detailed dietary history are paramount. An IVP may identify a risk factor for forming stones, ie ureteropelvic junction obstruction. Good luck.
If you are interested in referring your patient you may do so by calling Henry Ford Hospital or one of its urban campuses at  (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please provide  any physicians’ notes and lab test results that you  may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS-M.D. MS
* Keyword: kidney stones