My kidney stones are uric acid, not calcium, so need scope procedure not lithotripsy

I was having a lot of back pain on Monday so the urologist ordered a CT to make sure the stones had not moved and blocked the ureter.  I saw him yesterday,  and gave him the films from the xray last week.  None of the three large stones show up on the xray (and only two show up on the CT (but my intestines were pretty full thanks to the Vicodin)).  That means they are uric acid stones and that they cannot use x-ray to help guide them in order to do the lithotripsy, so I have to have a ureteroscope done (general anesthesia, but outpatient) so they can use a laser to blast the stones in the kidney and remove the larger pieces.  Ugh.  I was hoping not to have anything invasive done, not only because of the small change of complications (especially since I take blood thinner), but because of my PTSD (the idea of a male urologist -- even in a room full of nurses, anesthesiologist, etc. -- doing that type of surgery just raises my anxiety level).

I have to get these taken care of, though. One is 8x6mm, and one is 10x7mm, so they aren't going to be able to pass if they start to move out of the kidney.  There is also a 5mm one in the other kidney.

The interesting thing is that the info he gave me indicates that they are finding that soda, coffee, and alcohol (originally thought to be contributors to other kinds of kidney stones) don't contribute to stones after all.  A high level of animal protein in one's diet, however, does contribute to uric acid stones.  I need to clarify whether "animal protein" includes dairy.  The urologist raised the question of whether it was really necessary to get more than the 60g of protein recommended by my RNY surgeon (70 for men), so I have been searching some of the medical databases for any info I can find on true protein needs for RNY post-ops (as opposed to just eating protein to stay full).  My protein level is plenty high at 7.9, so it would not hurt me personally to drop my protein down 10g a day (and I don't get physically hungry so replacing some protein with a few more bites of veggies would actually lower my caloric intake), but I know some people have to eat significantly more protein in order to keep their protein and albumin levels up.  Anyway, it looks like I can have my Coke Zero again, but might have to decrease my protein.

Lora

Kidney stones are the worst. Hope you get better soon and I'm sure the procedure will go just fine.

Sending you healing vibes.

I just finished learning about uric acid stones last semester. You need to eat a low purine diet and perhaps be started on potassium citrate to help prevent further stone formation. The low purine diet is low protein but also recommends avoiding other foods, see here: http://www.med.nyu.edu/content?ChunkIID=213316 This is also the same sort of diet they put people on who have gout btw. I'm not sure if this info will help but I hope it does a little. I'm really sorry for your troubles...working in a hospital I see the pain of kidney stones in my patients...all I can say is I hope you get better soon and that the treatment will help! Take good care and keep us posted. I'll be thinking of you... :)

ps...this is from two of my texts:

Uric Acid

Uric acid stones compose 2 L/day and a urinary pH >6. Reducing dietary purines or the administration of allopurinol also helps reduce uric acid excretion. Alkalinization (with oral sodium bicarbonate, potassium bicarbonate, potassium citrate, or intravenous one-sixth normal sodium lactate) may dissolve calculi and is dependent on the stone surface area. Stone fragments after lithotripsy have a dramatically increased surface area and will dissolve more rapidly. Dissolution proceeds at approximately 1 cm of stone (as seen on KUB) per month, with compliant alkalinization.

Also...

Uric Acid Calculi

The average normal urinary pH is 5.8–5.9. Urinary pH is consistently < 5.5 in persons who form uric acid stones. The pK of uric acid is 5.75, at which point half of the uric acid is ionized as a urate salt and is soluble, while the other half is insoluble. Increasing the urinary pH above 6.2 dramatically increases uric acid solubility and can effectively dissolve large calculi at a rate of 1 cm per month as seen on plain abdominal radiographs, and effectively prevents future uric acid stone formation. Urinary alkalinization is the key to stone dissolution and prophylaxis. Potassium citrate is the most frequently used medication to increase urinary pH. It can be given in liquid preparation, as crystals that need to be taken with fluids, or as tablets (10 mEq), two by mouth three or four times daily. Patients with uric acid calculi should be given nitrazine pH paper with which to monitor the effectiveness of their urinary alkalinization; the goal is a urinary pH > 6.2 and < 6.5 (to avoid calcium phosphate precipitation). Other contributing factors include hyperuricemia, myeloproliferative disorders, malignancy with increased uric acid production, abrupt and dramatic weight loss, and uricosuric medications. If hyperuricemia is present, allopurinol (300 mg/d orally) may be given. Although pure uric acid stones are relatively radiolucent, most have some calcium components and can be visualized on plain abdominal radiographs. Renal ultrasonography is a helpful adjunct for appropriate diagnosis and long-term management.

Thanks for the info.  The weird thing -- even commented on by the urologist -- is that my urine PH is normal.  He is guessing that it may have been low for a certain period of time but is now back to normal... but he doesn't know why that might be.

Lora

Sorry you are having this problem!  So much conflicting info out there about how much we should have, I cant decide what to believe.

http://pamtremble.blogspot.com/2010/04/lets-talk-about-prote in-shakes.html

I was just reading more about protein requirements yesterday.  There are lots of links to research starters on the bottom of Pams blog above.  It kind of gives you more questions than answers.  very frustrating

I don't really see too much conflicting info (in general, on Pam's site, or in the links she gave), just some people who seem to believe that for some reason more is better.  There doesn't seem to be any question that the typical recommendation of RNY surgeons to get at least 60g of protein a day is appropriate... there are just a few sites/doctors that recommend much more than that.  Most of the discussions I have seen of eating more than 60g of protein don't actually recommend more, they just indicate that some people eat more than that. To turn that into "we  need 80g of protein" would be like saying that because some people eat Greek yogurt every day that all RNYers need to eat Greek yogurt every day.  

What I still have not seen anywhere is an medical reason for getting much more than 60g of protein daily since we don't malabsorb protein.  I don't think it matters whether someone is getting 70g if the need is only for 60g, but someone purposely eating more (and therefore eating more calories, of course) because they were told that we need close to 100g is a different story (and, potentially, could be the reason that the incidence of kidney stones is higher in RNYers).  In my case, decreasing my daily intake by 10g would also decrease my calories and probably wouldn't hurt my body since my protein level is above where it needs to be.

I do understand the frustration, though, that there isn't a definitive, universal set of post-op nutritional guidelines.

Lora

Yummy Diet Coke, lol I'm kidding I do drink one occasionally.  Hope the procedures goes well.

Ouch. Is there a chance you'll still have to pass small remnants too? Ouch.

Praying for you.

I would consider dairy products as animal protein, but there are lots of other protein sources of vegetable and grain origin that you can use to offset your intake.
Things like beans, legumes, nuts, and even the protein found in veggies like broccoli and mushrooms can count towards getting in adequate amounts.Also grains like quinoa and even brown rice will add to your intake.

I think you are right... decreasing your animal protein intake by 10 g would probably not negatively impact you. The body has tremendous ability to adapt to changes in intake. You are conscientious about monitoring your labs, so if cutting back did effect your labs you would be on top of it and could adjust intake to include more of the non-animal protein sources.

Hopefully the doctor will also have some other strategies for preventing more stones (fluids, meds, etc).

I wish you well!