Urology/Pelvic kidney with possible kidney stone
For background, I have a normal kidney on my left and a horseshoe kidney in my anterior right pelvis.
Two weeks ago I felt like I was beginning to get a UTI and my pelvic kidney was beginning to hurt. I gave a urine sample at the clinic and it showed trace bacteria, protein, white blood cells, and red blood cells. I started Bactrim that day, but had to stop taking it four days later due to developing an allergy to it.
I asked my PCP what antibiotic I could take to finish the course, since I am also allergic to Macrobid and Cipro. She had me come in to give another urine sample since my kidney pain had gotten worse. The new sample showed protein, white blood cells, and red blood cells, but no bacteria.
My PCP told me that she thinks I might have a kidney stone and wants me to see a urologist. The pain is a constant dull ache with occasional sharp pains that mostly occur when I feel my bladder filling. The sharp pain has also seemed to move over the past day.
I have questions about this. One, is that pain characteristic of a stone? I have heard that kidney stones are supposed to be the worst pain ever. This is definitely painful, but by no means the worst pain ever. And two, if it is a stone, will I need treatment to pass it given my abnormal anatomy? Or can I just drink lots of fluids and try to wait it out?
Amanda, the pain you are experiencing is not characteristic of a kidney stone. However with a horseshoe or pelvic kidney, it may be atypical. First, let us talk about your diagnosis. White blood cells (also referred to as WBCs or pus cells) in the urine generally indicate an inflammation somewhere in the urinary tract. The source can be anywhere from the kidneys to the bladder and urethra. However, it is very important, especially in a woman, to have the urine
collected so as to avoid contamination from vaginal secretions (which almost always contain WBCs and bacteria - and during your period red blood cells). This is usually done by collecting a proper mid-stream urinary sample after the vaginal opening and urethra are wiped several times with an antiseptic sponge. Not all women are successful with this technique. If doubt exists, a simple catheterized specimen should be accomplished as this sample is drawn directly from the bladder and prevents vaginal contamination. If indeed there are WBCs and/or bacteria in a properly collected specimen, the most common cause is infection in the urine. Bacteria may be seen under the microscope but a urine culture will definitively identify the infecting bacteria and drug sensitivity testing will help guide the proper antibiotic choice. In some patients with chronic hydronephrosis, the WBCs may just represent old inflammation and scarring in the tissues from previous damage and not an actual infection. Again, the culture will differentiate this. Other cause for WBCs not due to infection include a variety of inflammatory disorders such as papillary necrosis, various types of nephritis and nephroses, urinary stones, interstitial cystitis, tumors, etc. Often a thorough evaluation by a urologist is needed to find the specific cause. Hopefully, your urine samples were properly collected. Now let me give you some information regarding the pain characteritics and treatment options for kidney stones.
The kidney is made essentially of 2 portions: the parenchyma and the pelvo-calyceal system. The renal parenchyma is the outer meaty portion of the kidney which is constructed mainly of millions of tiny tubules that filter waste products from the blood for excretion in the form of urine. The interior of the kidney is a lined collecting cavity called the pelvo-calyceal into which the parenchymal tubules drain the urine. It is here in the pelvo-calyceal system that stones form. They usually lie free but on occasion may be attached. Stones that are in the kidney generally are painless. It is when they move out of the kidney causing either blockage of urine drainage or muscle spasm in the ureter (the tube that drain urine from the kidney to the bladder) that pain occurs. If the stone becomes lodged in the lower ureter, it characteristically causing irritation of the urinary bladder producing marked urinary frequency and urgency. Typically, this pain is unilateral, starts in the flank, radiates into the lower abdomen and then into the groin. The pain may be constant or intermittent, mild or severe but more often the latter. As the stone scrapes the lining of the urinary tract, blood in the urine is often noted. Movement of stones are spontaneous and may occur during activity, rest or sleep. Passage is unrelated to physical activity.
Imaging studies (usually an IVP or MRI) are needed to definitively diagnose urinary stones. The degree of obstruction, location and size of the stone all are factors in determining the likelihood of passage and treatment options. The latter includes conservatism (forcing fluids and taking pain medication as needed), extracorporeal shock wave lithotripsy (ESWL), endoscopic manipulation or, less commonly, open surgical removal. Intractable pain, severe kidney obstruction or signs of sepsis (fever, chills) are indications for prompt intervention. These options are the same regardless of whether you kidney is normally placed or ectopic in location.
I am not 100% convinced that your pain is related to the kidney. I think it is wise of your PCP to recommend a urologist & I suggest you call for an appointment. In the interim, I suggest forcing fluids to ensure a urine output of about 2 liters (quarts) a day and strain your urine for stones or gravel using fine mesh (like cheese cloth) or a stone screen that can usually be obtained through your pharmacist. Good luck.