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Forum Name: Miscellaneous Nephrology Topics
Question: Prolonged Intermittent kidney pain
|lalezzle - Sat Jul 07, 2007 12:25 pm|
Prolonged intermittent kidney pain
I am a 40-year old Caucasian female active, healthy weight, great blood pressure and not taking any medications, with the exception of occasional benadryl. At an active, healthy 27 I a stone became stuck in the lower ureter near the bladder and was removed via a cystascope (sp?). At 38, while on bedrest with a high risk pregnancy, a very large stone (8-10 mm) became stuck upper portion of my Left ureter where it stayed 3 months (until delivery). Initial treatment was a uretal stent then a nephrostomy tube. At some time after delivery, this stone passed and the tube was removed.
In the two years following the pregnancy I have intermittently had chronic-severe pain. I just had a diseased gallbladder removed (post-op one month) which seems to have alleviated some of my pain issues. Unfortunately, I continue to have kidneys that ache or feel as if they are being kicked or sometimes stabbed, particularly on my left flank or under my left rib. It seems to worsen in the evening, while I am sleeping accompanied by nausea and sometimes headache. The pain is significant enough to wake me from a dead sleep and is sometimes helped by a Lorotab 5 or 10.
I have done three, 24 hour urines and several blood tests with none of them showing anything out of the “normal” ranges, with the exception of slightly low magnesium in the urine samples. Based on a CT done in February, I do still have small stones in both kidneys. At least, three have passed.
Is there a condition of the kidney that could cause intermittent kidney pain and possibly contribute to the formation of stones that could be missed in typical blood and urine testing?
Could there be scarring or a physical abnormality of the kidney that is leading to the pain and stone formation?
Is it accurate to assume that the stones are the root of the pain?
|Dr. Chan Lowe - Tue Jul 17, 2007 7:12 pm|
You may have excess calcium in your urine (hypercalciuria). If you have stones at the time of the urine tests, the urine tests may not be reliable.
I would also suggest that the next time you pass a stone, it be sent to the lab to determine what type of stone it is.
You should consider seeing a kidney specialist to help determine if you need treatment for your stones or to help prevent more stones.
Also, just having high calcium in the urine can cause pain even if there is no stone present.
|lalezzle - Fri Aug 03, 2007 11:59 am|
Thank you Dr. Lowe. I
have had my stones analyzed. I believe that they were calcium phosphate. And there were stones present when I performed the urine tests. You are the first Dr. to explain that the urine tests may be affected by the presence of stones and that the high calcium can cause pain.
I had a CT this week that confirmed stones are present in both kidneys. Unfortunately, the pain has moved down to near my bladder, but no stones were seen on the CT in my ureter and no blood was detected in my very dilute urine. I don't know what to do next, request a cystoscope?
|Dr. Chan Lowe - Sat Aug 04, 2007 2:24 am|
Unfortunately, I'm not sure a cystoscopy will help much. Your pain is very consistent with kidney stones. If there were stones in both kidneys it is also possible that you have a smaller stone in the ureter that was simply not picked up by the CT scan.
Drinking lots of water will help flush stones out. I would recommend you see a urologist to discuss possibly doing some lithotripsy to break up the stones and make them easier to pass.
Magnesium and citrate in the urine help prevent the calcium from crystalizing in the urine to forms stones. Taking a multivitamine with the daily recommended amount of magnesium and, especially, citrate may help some.
With cacium phosphate stones it is also a good idea to look into causes like hyperparathyroidism or renal tubular acidosis that may increase the risk of forming calcium phosphate stones.
If you have stones present the urine tests are very unreliable so a "normal" result does not rule out high calcium levels.
Seeing a urologist may help with management of the stones you have now. Seeing a nephrologist may help with preventing future stones.
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