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Kidney Diseases

Nephrologist or Urologist

04/27/2007

Question:

I have been treated for kidney stones since late last year as well as one large stone in the left kidney that was there for several years apparently and which caused hydronephrosis, thin renal cortex, and function at 22%.

I continue to have symptoms of the hydronephrosis such as a feeling of pressure after eating or drinking and especially at night and a soft abdominal mass on the left rib cage that goes towards my side even though the stones and fragments should be gone by now.

I understand the left kidney may or may not regain function over time since it functions below 25% but I am surprise I am not feeling better. Should I follow-up with my urologist or go now to see a nephrologist for follow-up? What is the difference between the two specialties? Thank you.

P.S. Dr. Lam has been great answering a few questions for me last year. I wish she were in Los Angeles so I could se her since I trust her the most even though contact is only over the Internet. Thanks, Dr. Lam!!!

Answer:

Mildred Lam, MD

Your astute observations of pressure after eating/drinking and the soft mass in your left flank area do indeed suggest that you have significant left hydronephrosis.  In some cases, the kidney is considered to be irreparably damaged, and the patient is not subjected to procedures or surgery.  However, since you experience the feeling of pressure at times when your kidney would be expected to be making more urine (like after drinking), the left kidney may still have some function left, enough to be worth saving. 

In addition, if urine is flowing into the kidney and being blocked there, there is a risk of infection occurring in the stagnant urine behind the blockage.  I wonder if you might have scar tissue in the ureter as a result of the stone that was there before; if so, this should be able to be repaired or bypassed. 

You do need to see a urologist (a surgical kidney doctor), not a nephrologist (a medical kidney doctor like me)!  We will also send your question to a urologist at NetWellness, and get their opinion.

Martin Resnick, MD

I agree with Dr. Lam's comments.  You should have an imaging study e.g. CT scan withouth contrast to determine if any stones remain in the kidney and also a dynamic study e.g. renal scan with Lasix to determine drainage and document possible obstruction of the kidney.  It is very likely there is functional kidney material but the function of the kidney and the presence or absence of stone material needs to be determined.  A urologist should be able to do these studies for you.

I hope this information is helpful to you.

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University

Martin I Resnick, MD Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University