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,
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?
- 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.
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