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Back pain, fever, done CT scan, kidney stone, pyelonephritis, Cipro, Doxycycline, Augmentin ineffective

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General & Family Physician
Practicing since : 1997
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I have had chronic back pain in the kidney area, along with high fevers, the urologist said it is not my kidneys, I have had numerous CT scans that show several small 2mm stones. Along with reoccurring kidney infections (pyelonephritis) I have tried every antibiotic, cipro 500 mg, doxycycline 100 mg, augmentin, and still my fevers still continue with the pain. My general dr. says to see a urologist, my urologist says to see my general dr., no one will help, and I don't know what type of doctor to see?

Posted Sun, 6 May 2012 in Kidney Conditions
Answered by Dr. Savita Mishra 28 minutes later

Thanks for your query.

From your medical history, it is clear that you are suffering from bilateral multiple small calculi with recurrent pyelonephritis and fever presently. Here we have two major concerns:
1. Kidney function (primary concern)
2. Pain and fever.

As the stones are tiny and multiple, it is not a good case for ESWL (extracorporeal shock waves lithotripsy) as there is a substantial failure rate.

Also, invasive methods like PCNL (percutaneous neohrolithotripsy) is not a good idea in pyelonephritic kidneys.

The major approach in such cases would be to treat recurrent urine and kidney infection and keep an eye on the kidney function and extent of pyelonephritis. Few tests are indicated:
1. Urine routine microscopy every month and culture sensitivity.
2. Serum creatinine and blood urea nitrogen.
3. DTPA and DMSA scans for kidney fibrosis and kidney function.

Your present concern is pain and fever. Please get the following investigations urgently:
1. Urine routine and microscopy
2. Urine culture and sensitivity.
3. CBC- complete blood count
4. Serum creatinine and serum potassium

I would suggest to stop the current antibiotics for at least 2 days and then give the culture. Other investigations can be given right away. In this situation if the kidney function is OK, the infection should ideally be controlled by aminoglycoside group of drugs (gentamycin, amikacin etc) and then you need to be put on long term antibiotic prophylaxis.

Surgical interventions may be decided after reviewing CT scans. Send me the reports to my attention at YYYY@YYYY

Please do not take any pain killer except paracetamol till we are sure about normal kidney function.

Certainly, your urologist should guide you better and you need to be in long term followup of a good urologist and if indicated, you may be referred to nephrologist time to time.

Hope I have answered your query, I will be available to answer your follow up queries

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