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Have hydronephrosis, blood and leukocytes in urine. Ultrasound showed stones. Any insight?

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Hi, I am a 40 year old mother of two. I have been treated by a few different urologists regarding hydronephrosis of the right kidney, multiple UTI's and pain believed to be the result of hydronephrosis. One urologist found what he believed to be a stricture in the ureter and tried to open it up by burning the inside of the tube. It didn't fix the problem and actually seems to have worsened it (scar tissue), upgrading the hydronephrosis from mild to moderate. It was suggested that the original hydronephrosis may have been my normal anatomy.

I have a fair amount of infections I've been treated for, but only once had an acute kidney infection with high fever, about 12 years ago. It has also been debatable whether I've had subsequent kidney infections, depending on which urologist I've spoken to, or whether they were more limited to the bladder. The pain and hydronephrosis has worsened with some of these infections and resolved somewhat with their treatment.

I've had multiple CT scans and Nuclear Renal Scans, and it has been concluded that although there is delay in emptying the kidney, it clears with Lasix, so surgery to repair the Ureter won't help me.

My biggest concern currently is that something else is going on, which has yet to be acknowledged. I have intermittent blood and leukocytes in my urine (and sometimes a little bit of protein), at the same time I have symptoms of a UTI that are short-lived - the symptoms resolve after a day or so, as do the abnormal urinalysis results I am about to mention. I recently had a culture and urinalysis done while this was happening, which showed multiple colonizers, but no infection and a good amount of hemolyzed blood and leukocytes and leukocyte esterase. A few days later, I ended up having serious pain in my right side which I believed to be my kidney, on and off for a full day and then it resided to the normal occasional reminder of pain. At the start of the pain, etc., a test strip showed a minor amount of protein, as well, but it resolved quicker than the rest and by the time I had the urinalysis, it was negative for protein.

When I spoke to the nurse at my doctor's office, she told me the culture was negative, but my general practicioner wouldn't elaborate on the urinalysis findings. When I pushed for answers as to whether or not I should be concerned, she said my doctor directed me back to my urologist.

Well, my problem is that the current urologist basically agreed to monitor my hydronephrosis (via ultrasound once per year), but when I previously mentioned these other symptoms in my last visit, he really didn't have much to say. Maybe because he wasn't seeing it in print, maybe because he is not a specialist in that area - I'm not sure. A previous urologist told me I have had small stones (not struvite) on ultrasound, but none have ever been found non CT scan, nor have I ever noticed passing any.

I am wondering now if I should be consulting with a Nephrologist, or am I barking up the wrong tree? I am tired of not knowing whether to be concerned about these recurrent bouts, in addition to all of my other problems (Myasthenia Gravis, Auto-immune Thyroid Disease, Lymphocytic Colitis, Fibromyalgia, etc.). I just don't want to be ignoring symptoms that can be something serious because of this frustration.

Any insight you could offer or suggestion would be most helpful.

Thank you!
Posted Sun, 22 Apr 2012 in Kidney Conditions
Answered by Dr. Avinash Ignatius 12 hours later

Thanks for the query.

It is very difficult to determine whether the original issue was an anatomical variant. However having a documented delayed excretion of contrast may suggest some mild obstruction. But since with diuretic the flow is well, any further surgery may not give any benefit.

Intermittent RBCs (Red Blood Cells), WBCs (White Blood Cells) can be due to the existing scar, even in the absence of an infection. Occasional trace or 1+ protein also is of not much significance.

However if you have recurrent symptoms of UTI (long term suppressive therapy of 3 to 6 months with an antibiotic, it may help in clearing off any residual infection.

Monitoring the progress of Hydronephrosis annually seems quite good and more reliable.

You should definitely consult a Nephrologist.

Hope I have answered your query. Please accept my answer in case you do not have further queries.


Above answer was peer-reviewed by
Follow-up: Have hydronephrosis, blood and leukocytes in urine. Ultrasound showed stones. Any insight? 1 hour later
Thank you for your reply. I just want to point out some additional details and clarify a couple of things and get your take.

I've never been on long-term antibiotics because no one has suggested that I needed to be. And the culture I had last week was negative, except for colonizers. Could these ever present a problem?

The problem is the intermittent symptoms of a UTI coinciding the intermittent irregular urinalysis reports. In addition to the sometimes severe kidney pain.

Another factor is that I have seem to become gluten intolerant probably as a result of lymphocytic colitis, so I've gone back to a relatively carb free diet. Could that be causing any of these irregularities or the kidney pain? Like too much protein and strain on the kidneys?

Or could I have something like glomerulonephritis or lupus or even cancer or something? Or are you saying I shouldn't be concerned at all because its probably just the scar tissue? Or maybe small stones having a hard time passing through the scat tissue. Or something from taking to much medicine in my life? I don't take that much now, but I used to take antidepressants and NSAIDs and sleep aids, etc for years for Fibromyalgia.

And finally, do you think a Nephrologist would be more appropriate at this point than a Urologist? I just don't want to go there and have them tell me I belong back at the Urologist. I do have a yearly check up almost a year away for the Urologist. I just don't know which is appropriate at this point and where you draw the line between specialties.

Thank you.
Answered by Dr. Avinash Ignatius 4 hours later

Thank you for the follow-up.

There is no absolutely correct answer, as your cultures have been negative. Rarely Behcet's syndrome may mimic your symptoms.

Your renal function has not been mentioned. But it would be worthwhile getting a Nephrologist to see you.

Hope I my answer will be of some help to you. Please write back with your reports if possible and please accept the answer if you have no further queries.

Wishing you a speedy recovery.

Above answer was peer-reviewed by
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