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Kidney Diseases

Kidney Stones - Comprehensive Treatment Ctr

06/02/2009

Question:

I have had chronic kidney stones since 1991. I have passed or gotten rid of over 20 stones. I am 38 years old and my urologist put me on hydroclorizide to help me not form stones but since then I have started getting gout. I had over 60 percent of my liver taken out in 2001 and it ended up being nothing at all. I got a staph infection after. With all that the stones are still giving me problems. Just this last week I started having pain in my right flank in the middle of the night and I thought it was kidney stone. I actually got really bad and I went to my urologist and he said kidneys clear and no obstruction. Well after I got home the pain got realy bad especially when breathed or moved. I ended up going to see my neighbor at the ER (he is an ER doctor). He took a chest xray and he thought I had pneumonia which he found wierd because I have not had any symptoms of being sick. He then drew blood and checked my white blood cell count and the D-dimer test to make sure no embalism. Both these test came back good so he concurred that I had either pulled muscle but more likely plurescy(lung membrane). I really am just ready to find a place who can look at my total medical situation not just the speciality. I was wondering if you know of any of these centers that do an overall check of systems. I have the resources and the time to spend. My wife and I are expecting our first son in June and I am just ready to get my health on track the right way. Thanks!

Answer:

You have certainly had a lot of problems for someone who's only 38 -- on reading through your history, I am uncertain whether and how these problems are related.  I'm particularly puzzled by your having had more than half of your liver removed for "nothing at all."  Based on the symptoms you describe, I am inclined to agree with your neighbor who thinks that you have pleurisy.  However, that raises the question: why do you have pleurisy?  Pleurisy is not a disease in itself, but develops as a result of an underlying disease, such as pneumonia, tuberculosis, pulmonary embolism, cancer, and others.  I am also wondering if what's going on in the lining of your lung could possibly be related to whatever the liver abnormality was thought to be in 2001; or if something is now happening only in the liver, causing the right-sided pain. 

It sounds like the best place for you to start would be with a thorough history and physical exam by a general internist (specialist in internal medicine).  While you could go to a comprehensive treatment center such as Cleveland Clinic or Mayo Clinic, which are geared up to do comprehensive evaluations on out-of-town people in 1-2 days, I think that this might be overkill (especially financially) for your situation.  A good internist should be able to put everything together, order some basic studies (probably including a chest and abdominal CAT scan), and then recommend what type of specialist you need to see.  I would try to go to a large teaching center if possible, but the most important thing that you can do is to bring copies of your records, your lab tests, and actual x-rays with you for review.  Be aware that  serial exams and lab values will be of great interest and importance to the physician who sees you -- changes in blood tests and/or in the radiologic appearance of your organs (such as liver, lung, kidneys) may provide an important clue to what's going on now.  Good luck, and please write back when you get your diagnosis -- I will be most interested to hear how things turned out.

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Response by:

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