Kidney Infection - Doc suggesting removal of Kidney

[youngguy34]

It started with a pain on the right side, fever and UTI in June. Did ultrasound which revealed right kidney is 7cm, IVP should less functioning right side, lasix renogram showed 18% working right side, Urethroscopy and Cystoscopy reveald a block on the kidney and bladder junction, but no infection was found in the sample retrieved from the kidney directly. CIPRO was given and now out of UTI since end of August. But got pain, fever back in mid October now Doctor is advising removal of right side. Its kind of a shock as this is the 2nd time I am getting pain and already being told to remove the right kidney, not sure whether there are more treatment options available instead of just it out. Doctor says this is the safe route of taking it out, but its a major surgery so looking for alternate options to treat the situation.

Would appreciate an answer

[Stephen Liroff, MD]

I must say that the urologist who has you in his office and can go over fine points in your history is in the best position to advise you.
You may not develop resistant bacteria, in which case you will do fine but will need to take medication indefinitely.
Nephrectomy is  not a terrible thing and I would expect you to do well on only one kidney.
As an alternative, stay on antibiotics, have a stent (internal tube running from your bladder to your kidney) placed and repeat the lasix renogram in 3-6 months. If the functin improves significantly, go for the repair. If deterioration and recurrent infections,  then go for the nephrectomy.
S.A.Liroff, M.D.

[youngguy34]

Hi Stephen Liroff, MD

Appreciate your reply

Option 1 - Removing the structural problem - my urologist says the benefit from this is less because my right kidney has very minimal function and very minimal meat in it to revive anymore. Also it will be an easy target for infection like it is now and I will have to end up removing the kidney sooner (like in a year or so)

What is your opinion and experience with this option has it led people to end up removing it. My family is afraid of frequent surgeries.

Option 2 - Antibiotics my urologist says might work for couple of months and then the bacteria might get resistant and cause more trouble

Option 3 - my left kidney is working 85% and my right kidney is working it seems only 15%, they are suggesting to remove the right which is the source of the problem and then take care of the left by diet and regular checkups

I have actually consulted 3 urologist in my region and all of them have come up with the same suggestion

Your inputs are greatly appreciated

Thanks

[Stephen Liroff, MD]

The recommendation to remove your poorly functioning kidney should be based on the level of kidney function as well as the site of recurrent infections. The alternatives are (1) resolve the structural problem that has lead to these infections (2) keep you on antibiotic prophylaxis indefinitely (3) remove the kidney. Correcting the obstruction can be done by several methods but if they fail then you are left with a repeat attempt to eliminate the blockage or #2 or #3.
Indefinite (really life long) prophylaxis exposes you to the side effects of the antibiotic, the risk of the development of bacterial resistance (not your resistance, the bacteria's) as well as the life long expense. If ineffective, then you'll need to consider #1 or #3.
Kidney removal, nephrectomy, may be the way to get over the problem quickly and move on.
The decision to operate also takes into consideration the status of the opposite kidney. If that kidney is not working well then you would work extra hard to preserve and improve the function of the kidney that you are thinking of removing.
Putting it all together, at 18 % function, my tendency would be to preserve that kidney by correcting the problem recognizing that doing so may result in a surgical  complication that could require removal.
Hope that this helps in making your decision.
S.A.Liroff, M.D.

[youngguy34]

Hi rmprdl1964

Appreciate your reply

I have talked with a couple of urologist and all seem to be saying the same. The reason they are quoting is my right kidney does not have enough meat in it for it to revive back.

The infection I am having is PSEUDOMONAS ARIGUNOSO and its repeated for couple of months. My right kidney is being said to be an sitting duck as it has shrunk in size in the last 5 years. Also they are saying antibiotics for a long time will not remove the problem totally but only suppress them for some time.

Is your situation any close to mine, if you can give me some details I can ask my urologist about them

Thanks

[rmprdl1964]

The suggestion seems to be quite agressive. I used to come down with many kidney infections of both sides. Never has any urologist suggested removal of a kidney.
If this is the first urologist that you have seen, I would suggest another opinion from a different urologist.

I too would be worried, the removal of a kidney seems to be taken quite lightly by this doctor. Maybe there is a chance of a surgery the correct the defect.

Good luck