Have Renal Stones. Having Increase In Pain. What Can Be Done Further?

Posted on Mon, 3 Jun 2013

Question: I have renal stones from last more than 10years. In the past i have passed out multiple stones through urine. But recently the frequency of pain due to stones have increased. I experience frequent pain after long travel or hard physical exercise. I had undergone various diagnostic tests and advices. But still i didn't receive any concrete solution. Please advice the future course of action.

Answered by Dr. V. Sasanka (6 hours later)

Hi,
I went through all your reports. Most of them seem to be from 2010.
If you have presence of stones causing pain, and it is getting worse, you do require treatment for the stone causing pain. This stone, if present in the ureter, may need Ureteroscopic lithotripsy with laser or push back into kidney and PCNL or ESWL. Either way, once the procedure is done, and you are free from pain, and you are back to normal diet and fluids, you might require to get a detailed evaluation done. This will include evaluation for an entity called Renal Tubular Acidosis, which often causes a similar picture. Also on one occasion your parathyroid hormone was mildly elevated. that will require renewed attention.
There are some centres which do an evaluation of urine which is collected over 24 hours, and find out which salt is high, which is low. They might see if calcium, phosphorus, oxalate in urine are high or if citrate and magnesium are low, which should be in high amounts as these two are inhibitors of stone formation. Depending on what turns up on these investigations, we can plan further treatment. This will help avoid or limit recurrence of stones in the future.
Hope I have been able to help you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. V. Sasanka (43 hours later)

Hi Doctor,

Thanks for all your advice.

I recently experienced pain in last few months and undergone some tests. So I am attaching few more reports for your reference.

I also consulted Dr. XXXXXXX XXXXXXX Visiting Urologist at L. H. Hiranandani Hospital, Powai, Mumbai. She didn't asked me for any of the above procedure which you have recommended.

So, firstly can you please elaborate how and when I can undergo such tests? Also, can you please recommend some change in food habits or advice me for specific food items which will help inhibit stone formation or help to excrete them.

Please suggest if there is any permanent solution/therapy for this condition?

It will also be helpful if you please suggest some painkillers which have minimal side effects and can be used wisely as i am getting frequent incidence of pain.

Thanks and regards,

XXXXXX

Answered by Dr. V. Sasanka (19 hours later)

Hi,
I have seen your reports. They are dated October 2012, when you apparently had swelling in your left kidney. The doctor had suggested that you repeat an ultrasound examination. I suggest that you please get this done, if you have not already got it done.
You also might need to get a CT scan of your KUB area if the ultrasound picture confirms persistence of hydronephrosis which is swelling of the kidneys.
I do not think that right now there is a permanent cure for your condition.
I doubt if any amount of radical alteration of diet is going to prevent stone formation in your case, but I suggest that you reduce the salt in your diet. Also, if you eat an oxalate XXXXXXX diet, you might cut this down - this will mean less tomatoes, spinach, rhubarb, cauliflower, broccoli, dark chocolate, dry fruits and nuts.
Drinking plenty of fluids is most important, and I suggest you take enough for you to be able to void 8-10 times through the day. That will mean an intake of 4-5 litres of fluids so that urine output will be at least 3-4 litres per day.
As regards the tests, they are the ones I told you in my last message, and I guess any good hospital in Mumbai or Delhi will do a decent job. I am based in Hyderabad, so I am more familiar with this part of the country.
Spasmoproxyvon as an analgesic for kidney stone pain is fairly effective and extremely safe.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. V. Sasanka (5 hours later)

Thank you Doctor.

I will try to get these tests done as and when my schedule allows and will also try to alter my food habits a little bit.

However, the painkiller Spasmoproxyvon is a Schedule H drug and is not easily available without a same day prescription. So please suggest a suitable substitute or any other painkiller.

Thanks again for all your efforts and suggestions.

Best,
XXXXXX

Answered by Dr. V. Sasanka (44 minutes later)

Hmmm...
You can try a tablet containing a drug marketed as Buscopan. This usually is safe, but I do not know regarding availability without prescription in USA.
Let me know your progress once you get your reports.
Regards.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar