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Chronic cystitis after removing KIDNEY STONES by KEY-HOLE SURGERY.

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My father is suffering from chronic cystitis. less than br greater than less than br greater than History: less than br greater than Kidney stones removed 2-3 years old patientback with key-hole surgery. less than br greater than less than br greater than About 10-11 weeks back, he started getting blood in urine and burning sensation. Creat was 2.7 then. He was given some anti-biotics, but creat started increasing. Creatinine serum reached 5.1. Urine culture detected Candida 10,000 colonies & pus cells at 80-90. We consulted a nephrologist and he was admitted and given meropenem for 2 weeks. They also performed stenting on the left kidney. He got discharged after 2 weeks with Creat down to 3.1. less than br greater than less than br greater than After 2 weeks at home, even though clinically he was doing ok, Creat had increased again to 6.2, he was then admitted again for 3 weeks. Urine culture showed klebsiella pneumonia bacteria 5000 colonies. Meropenem (1.5 g) was given again, this time for 3 weeks, along with fluconazole 0.5 gm. Stenting was again and this time for both kidneys and asked to keep for 6 months. He was discharged last week with Creat reaching stable at 3.6 for the last week. less than br greater than less than br greater than They also started TB medications. Even though MGIT test shows no growth and biopsy was also clear w/ no TB signs.. This was suggested by the surgeon who performed stenting. less than br greater than less than br greater than Last week, we got the test done again for follow-up, and Creatinine had reached 4.4 and Pus cells at 60-70. Reports attached. Doctor told to continue the same medications and have lots of food. less than br greater than less than br greater than Here's the list of current medication: less than br greater than less than br greater than RCin 450 - once daily less than br greater than INH 300 - once daily less than br greater than ETB 800 - once every alt day less than br greater than PZA 750 - twice every alt day less than br greater than benade 40 - half daily less than br greater than ------ less than br greater than Silotime 8mg - once every night less than br greater than Solitral - once every morning less than br greater than Zolfresh 5mg - before sleeping less than br greater than Cap Augment 375 - twice daily less than br greater than Febuget 40 - once daily less than br greater than less than br greater than He has been asked for a follow-up on coming Tuesday. less than br greater than less than br greater than I needed a second opinion on this. Also, he has started coughing since last 4-5 days and feels nausea when coughing. He gets hungry but he is not able to eat much solid and he is feeling weak too. less than br greater than less than br greater than less than br greater than Please advise.


Category: Nephrologist

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Category: Pediatric Nephrologist
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Expert:  Dr. Sree Bhushan Raju replied 4 Days ago

Hello,
Thank you for your query at DoctorSpring.com

your father was treated appropriately though a bit late. Stones and infections make scars in the kidney which will slowly and gradually spread across the kidney ( called fibrosis) and further damage the kidneys. Your father should have been treated early for stones and adequately for the initial and first urine infection. when you don't treat first urine infection adequately ( dose , drug and duration ...matter ) .. Diabetics, old people and some drugs which decrease the immune system will further increase the risk. He needs a lot of other tests also after a consultation by a nephrologist.
Feel free to discuss further,

Regards

Dr. D. Sree Bhushan Raju
MD, DM ( AIIMS), DNB, MNAMS, FICP, FISN, FIACM


Patient replied :

Thanks Doctor. He doesn't have any history of hypertension or diabetes. I feel the antibiotics he took before the culture and sensitivity test worsened the infection. I would like to know a few things 1. how we can identify if TB medicines are working because all the TB tests were negative. 2. How we can preserve the functioning part of the kidneys in the future, for how long would that be possible. 3. Also, please let me know the other tests required as you mentioned. We are going for CBC, RP and SGPT tomorrow. 4. Any method we can increase his food intake?
Thanks.


Expert:  Dr. Sree Bhushan Raju replied 3 Days ago

- Was any TB test taken before starting the medicines?
- Has he been examined by a nephrologist till now?
He definitely needed the antibiotic, he is excreting a lot of pus cells, and it shows the infection is not getting treated. If the infection is adequately managed, his kidney can be preserved.
Did you get his SGPT reports? The loss of appetite could be related to that.


Patient replied :

Yes Doctor. He has been treated by a Nephrologist..
First instance was 9 weeks back - he was admitted for 2 weeks on meropenem and stenting of left ureter - Creat came down from 5.2 to 3.1.
Second instance was 5 weeks back - he was admitted for 3 weeks on meropenem and fluconazole and stenting of both ureters. Creat came down from 6.2 to 3.6
MGIT TB and biopsy of bladder for TB were negative.
SGPT was done yesterday, ALT has become 79 now.
Attaching yesterday's reports. Sodium was too low in morn - 111, we got it done again in eve and it was 118.
Creat has decreased to 4.1 now from 4.4 last week, but pus cells have gone up to 120+ now.


Expert:  Dr. Sree Bhushan Raju replied 2 Days ago

TB affects every part and organ of the body and has a varieties of ways of manifestations. No two patients manifest in a similar way and not all the evidences appear at the same time. Hence most of the physicians in our country suspect and treat empirically. Repeated episodes of urine infections in an otherwise unpredisposed patient( non diabetic and has no risk factors) TB should be suspected . He must have been started on TB based in systemic symptoms loss of appetite , fever etc. TB drugs should be carefully monitored by liver function tests initially as they can derange liver functions in some. TB takes few weeks to improves though he needs to take drugs for an year or so so that his general condition would improve
Encourage him to eat well
Creat goes up and down with every infection and effective treatment

Fungal infection also should be treated if not with fluconazole with inj amphotericin


Dr. Sree Bhushan Raju
Category: Pediatric Nephrologist
Experience: 
FISN : Fellowship of Indian Society of Nephrology(ISN), 2012
FIACM : Fellowship of Indian Association of Clinical Medicin(IACM), 2012
FICP: Indian College of Physicians Association of Physicians of India, 2012
Fellowship: DM, DNB, All India Institute of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, Nizam's Institute of Medical Sciences, 1998
Medical School: MBBS, Gandhi Medical College, 1994
Dr. Sree Bhushan Raju and 4 other Medical Specialists are ready to help you

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