Question: I am a 68 yr old male with metabolic syndrome(hypertension,hyperlipidemia,hyperuricemia,controlled SVT since my 20's,kidney stones, elevated BMI at 28)on medications including metoprolol,lisinopril,rosuvastatin, fenofibrate,Co enzyme Q10, multivitamins with mineral supplements, enteric coated aspirin, and naproxen. I have had 2 calcium oxalate tiny urinary tract stones in the past 26 yrs. my question would regard possibility of having a uric acid stone during resolution of a gout flare (left second toe symptomatic) when I had to go off aspirin and naproxen and vitamin E for 2 weeks in preparation for back surgery 7/24/17 (hemilaminectomy,microdissectomy,L4,L5 nerve root decompression on Right).gout attack started day 8 off naproxen,aspirin and resolved with 5 days of colchicine,ice elevation and elixir of time. My stone episode days prior to back surgery this time passed within 7 hrs of onset of Right lower quadrant pain with ache in right testicle and moderate blood on urine dipstick that resolved promptly with resolution of the symptoms. Unfortunately wasn't able to retrieve the tiny XXXXXXX colored 1 mm presumed stone for analysis to see if it was indeed calcium oxalate like my prior 2 analyzed stones. Uric acid following stone and gout episode slightly elevated at 8.2. So what do you think? Previous CT of abdomen and pelvis after previous stone early 2016 showed a couple of cysts in the kidneys along with too numerous to count 1-3 mm apparent stones in both kidneys. This was consistant with ultrasound of kidneys and bladder obtained when my MRI for lumbosacral problems showed presumed stones and cysts in august of 2015.

Other question revolves around recent increase in creatinine from 1.3 to 1.51, BUN increase from 28 to upper 30's and egfr (had been 51) decreasing to upper 30's preop for back surgery. I had already stopped the naproxen and cut back on lisinopril from 40 to 20mg a day without rebound in hypertension(controlled in 130/78). Will be seeing my primary care again later in August and requesting nephrology referral at that time. GlycoA1c stable at 6.1 and no protein hematuria or microalbumineria
What other evaluation or recommendations regarding the possibility of chronic kidney disease. I've already started increasing my fluid intake along with more judicious attempts at weight loss to relieve Lumbar spinal load as well as better control the metabolic syndrome with successfully getting from 180 to 172 pounds for my weight with target of 160-165 . Thank you XXXXXXX F

Thank you for your informative response. Quick follow up question regarding medication choices for arthritis and hypertension given my decreased eGR and rising creatinine and BUN values. Is the decreased renal blood flow family specific for all nsaids and ace/ arb's? Would switching from naproxen to Celebrex for arthritis/pain relief and lisinopril to a different ace or arb to control hypertension and prevent proteinuria secondary to metabolic syndrome implications be beneficial for preserving renal function or is it trial and error when switching from one drug family member to another? I still plan to see my primary care doc next week and follow thru with a nephrology consult.
Respectfully,
XXXXXXX F

Thank you for the updates. I will keep you posted.
Respectfully,
XXXXXXX F