Renal colic

[debbie]

For the past 1 1/2 yrs. I have been suffering from renal colic and it's been making my life miserable.  I have had numerous calcium oxlate stones, chronic kidney infections, (I am on cipro 500mg. daily) and I had UPJ obstruction. I had a stent placed in to try to correct it, that failed.  I had my kidney diliated, that failed.  And in March I had a open pyeloplasty.  I was pain free for a few months after that.  In the end of June I passed another stone and started with more infections. I had a IVP done no more stones were found. They did find a mild obstruction and severe tissue lost in the right kidney.  My pain still continues. I had another IVP done about a month ago. Once again no stones, mild obstruction with severe tissue loss and delayed clearance.  2 days after that IVP however I passed a stone.  Lab results were calcium oxlate which should of been seen on the IVP.  I also pass alot of white milkly looking stuff in my urine.  My Uro. says it is probably calcium deposits.  I also have been passing alot of very small stones which hurt almost as much as the larger ones.  My Uro. had me tested for hyperparathyroidism, my levels were normal.  I go back to see him in 2 wks.  He said that my kidney was in very poor condition when he did the pyeloplasty from all the chronic infections and the obstruction.  A year ago I had only 25% function in the right kidney, not sure what it is now. The renal colic is daily and I take darvocet for it when I am not at work.  This is really interfering with my life, I had to call in today cause I felt to sick. My left kidney is now beginning to cause me the same pain but not as often.  I try to watch my oxlates and try to take in a balanced amout of calcium, not too much or too little.  I think he may no be considering removing the kidney, but not reallly sure.  Any ideas or comments would be helpful. Thank you.

[HFHS M.D.-BE]

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Dear Debbie,
According to what you have said, it seems that the primary site of the problem is the right side. In the face of a 25% function the removal of the kidney is harder to justify than if there were more deterioration of the function. There are two things that your urologist might want to do. First, is to obtain another renal scan to determine if the function has deteriorated further, or stayed the same or improved.  Second, a metabolic process causing or worsening your stone formation should be ruled out. He has already looked at your parathyroid. The other thing is to get a 24hr. urine, and also make sure you don’t have a malabsorption problem.
By modifying your diet for oxalate and increasing your fluid intake, as well as alkalinizing your urine you may acheive some progress.  If a malabsorption problem is present, it has to be addressed also.
The obstruction with the delayed clearance might be as a result of scar tissue formation and strictures. In the face of this and continued stone formation and infection a reoperation might be considered, provided that the kidney function is still good. This may be done via either open revision of the endopyelotomy(open surgery) or  percutaneous endopyelotomy/incision of stricture(surgery through a scope). By a combination of surgery and addressing metabolic issues you may do better than before.
On the other hand, with a poorly functioning kidney, and continued stones and infections and their associated morbidities, a kidney removal might serve you better, especially if your other(left) kidney has good function. You should discuss this with your urologist.

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. More individualized care is available at the Henry Ford Hospital and its urban campuses by calling  (1 800 653 6568).

Sincerely;
HFHS-M.D. BE
* Keyword: UPJ and Stones

[tami]

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[tami]

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[rohit_tiwari]

A related discussion, Kdiney Stone was started.