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Treatment other than operation for Ureteric stone in diabetic with hypertension - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Kidney Conditions
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
Doctor :   Hi
Doctor :  
How can i help you?
User :   Hello. Yes please. I'm not sure if I have spoken to you before since I've visited this chat but its about my father. Please read through previous chat history.
Doctor :  
one min please
User :   Take your time sir.
Doctor :  
yes proceed with your query
User :   He has a history of high blood pressure, gout and most recently diabetes. Also gout attacks that had him in bed for two months now. His current ailment, if one can called it that is his kidneys. Last night I rushed him to the E.R. because of abdonimal pain. Everything in his blood sample seemed ok only elevated kidney levels. Becuase of his great pain, the Dr. did ordered
Doctor :   yes i could see this in the previous records

User :   an x-ray on his stomach and kidneys that showed a 5 milimeter kidney stone that is lodged in between his left kidney and bladder.
Doctor :   ok
User :   Because is about 5 milimeters they want him to flush it out through his urine but if he is unable to, maybe an operation is an option.
Doctor :  
User :   My father is very scared now.
User :   He is afraid of a possible operation...
User :   They admitted him at the urology/surgeon and reumatology ward today.
Doctor :   Now a days a kidney stone rarely require operation
Doctor :   there is no need to panic as the stone is only 5 mm and it is in ureter
Doctor :  
it will usually pass out by flush theraphy
Doctor :   if that fails than the stone will be broken into pieces and made to pass out
Doctor :  
this is also non operative
User :   And if it doesnt? How long can they avoid before opting for an operation? Since it blocks urine
Doctor :   urine is not blocked, it is partially obstructing the flow

User :   I understand. Since he has other ailments, I'm afraid of the risks that may occur if a operation is a choice to go. Should my father obstain from an operation?
Doctor :  
operation is not a choice for 5 mm stone
User :   That sounds assuring.
Doctor :  
up to 15 mm stone uretoroscopic retrevial with basketery is been done
Doctor :   operation is for huge kidney stone called stag horn stone with not functioning kidney
Doctor :  
in this case the stone is in the lower ureter and not in kidney
User :   I see. Becuase his knee and feet are swollen, is this the Gout acting up or the kidney stone that is obstructing the flow?
Doctor :   may i know his recent uric acid levels?
User :   2-3 months ago it was like 400 something, yesterday and today its about 140-160 something
User :   Because of anti-inflammatory medicines his kidney levels were much high but today there are much better but the Dr. told my father that it will never be perfect.
User :   He has also mentioned to me that in the morning he urines fine, its later in the day when he has troublety
User :   Sorry about my bad spelling or if I'm hard to "read"....
Doctor :   the possibility of the stone may be become of the gout, it needs to be tested after he passes out the stone
Doctor :   no problem
Doctor :  
here you need not worry about the stone as it will not require surgery
Doctor :  
the blood glucose and the hypertension and the gout need to be kept in check
User :   But how long does it usually take before he can past out the stone by himself, is it person by person?
User :   Yes they do need to be kept in check and they are. He has usual visits with his Dr.
User :   Just out of curiosity, why didnt the stone show in my father's urine, blood test or even on a ultrasound they did on his kidneys few years back.
Doctor :   if the flush therapy is successful usually with in 48 hours he should pass out the stone
User :   There is no blood in the urine or any anal bleeding, it only showed on the x-ray.
Doctor :   the stone will not usually show up in any of the blood tests
User :   And another thing, the stone must have been there for quite some time, why did my father experience pain yesterday and today???
Doctor :   the stone gives symptoms only when it starts moving, and not when they are forming at one place
User :   Are there any kind of foods, bevrages or drugs he should avoid and stay away from?
Doctor :   as the stone was seen on x ray it seem more of an calcium types
Doctor :   so needs to avoid the food stuff rich in the calcium content
User :   what does that mean exactly in laymen terms please'
Doctor :   kidney stones are of many types
User :   Milk?
Doctor :  
calcium stones
User :   Creme?
Doctor :  
gout stones
Doctor :  
mixed stones
Doctor :  
pigment stones
Doctor :  
User :   I see. (reading with interest).
Doctor :   the stone are visible in plane x ray only when they are made of calcium
User :   So am I to understand that different stones equal different measures?
User :   Or is the procedure the same no matter what kind?
Doctor :   yes
User :   Yes, the same of different in procedure?
User :   or
Doctor :   the reasons to form stone is different but the treatment option for all of them is universal
Doctor :   the same
User :   Ok, I get it now
Doctor :   treatment depends on the place of the stone and the size of the stone
User :   Do they need to analyze the stone to know what kind it is, right?
User :   Its like I mentioned earlier
Doctor :  
that is after he pass out the stone
User :   lodged between the left kidney and the bladder
Doctor :  
the structure between the kidney and bladder is ureter
Doctor :  
so it is a ureteric stone
User :   So do I need to worry??? It is, so what should he avoid from now on?
Doctor :   as i said earlier you need not worry on the present stone as it will not require surgery and it will be made to pass out in his urine
User :   How about his kidney, will they better if the passes out the stone through urine?
User :   Sorry if I'm repetative but I want to be sure.
Doctor :  
stone is not causing his kidney any problem
User :   but the levels are elevated
User :   ok
Doctor :  
it is the diabetes and hypertension which is causing the kidney problem
User :   Really. But his blood sugar levels are around 6-7 after eating something and he takes medications for his high blood pressure but not the diabetes becuase his levels are satisfactory his Dr said
User :   So what can he do, aside from taking medicine for his blood pressure, gout
Doctor :   medicines only controll the blood level of sugar

User :   I realise you can answer my next question since you dont know my father or have not treated him but why was he off the diabetes medicine
Doctor :   from when he was put off the diabetes medicine
User :   So should he take them or what?
Doctor :   from when he was put off the diabetes medicine
User :   yes???..........
Doctor :   when was he started on diabetes medicine and when was he stopped ?
User :   He was diagnosed with Diabetes in October 2008. He started with 500 mg Glucophage 1x1 and then raised the dosage to 500 mg 2 tablets a day. Today he has shed nearly 10 kg and his levels are like stated earlier satisfactory by his Dr. at the kidney ward
User :   He has been off them for 4-5 months now I think
Doctor :  
User :   The Dr claimed that they were not so good for his kidneys so she told him to NOT take them cause his sugar levels were satisfactory
Doctor :  
the medicines are started or stopped only on the basis of the blood glucose levels. if the blood glucose level does maintain with in 120mg/dl then no need to take medicines
User :   But then again he is still over-weight. When he was young he was never, ever over weight. There is diabetes, kidney stones, gout and gall stones in the family.
Doctor :   ok
User :   But for the past 4-7 years he has been over weight
User :   and has had gout attacks
Doctor :   ok

User :   So should be on them or not and if not, is there any chance that new stones can develop?
Doctor :   if the is fasting blood glucose with in 120mg/dl
Doctor :  
than he need not start the medicines again
User :   so why the produce of kidney stones?
User :   why are they forming if his levels are in check?
Doctor :   blood glucose is not forming the kidney stone and there is no relation for the kidney stone formation to the blood glucose
Doctor :  
it is the gout which is the culprit along with the long standing hypertension
User :   I see.
Doctor :   also hypertension damages the kidney gradually
User :   Really. I see
Doctor :  
that is the reason he has high levels of urea and creatinine
User :   Ok
Doctor :   did you got it now why he is facing problem with the stone in his kidney now

User :   I would like to think so. Yes, I have
User :   I'm gonna print this chat conversation and talk to my father's Dr. He will be glad to know that an operation will not be necassary
User :   Thank you so much for your great advice and patience.
Doctor :   yeah for the small stone operation is not necessary and there are techniques to remove the stone with out operation

Doctor :   please fill the feed back form
Doctor :   is there any thing else i can help you with
User :   i will. I'm good thanks and have a wonderful day
Doctor :   thanks for consulting health care magic
Doctor :  
bye for now
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