Q: My 78 years old father is hypertensive for the last few years. Two years back he underwent TURP and removal of a stone from the urinary bladder. At that time, his left kidney also showed a 14 mm calculus in the lower pole and a 7 mm calculus in the mid pole. His blood urea level also increased to 47 mg/dl but the creatinine was normal. Recent ultrasonography of kidney, ureter and bladder (KUB) shows that the 14 mm stone has increased to 18 mm, while the other remains unchanged. The report also indicated bilateral renal parenchymal disease. The urologist says it is not a cause for worry and because of my father’s age, he does not want to risk lithotripsy. Do we need to consult a nephrologist? What diet is helpful and what can be the complications?

A:Although you didn't give creatinine value, you father's blood urea is almost normal. It is true that kidneys 'age' as we grow older. However, to diagnose kidney disease, in addition to blood tests and kidney imaging, we also need to do urine studies. Regarding the stones, the stones in ureter (tube that connects kidney to bladder) cause symptoms and stones within kidney itself do not usually cause any problems. It seems reasonable to see a nephrologist for thorough evaluation especially if he is having attacks of pain from stones. This evaluation will include 24 hour urine collection for volume, PH, sodium, creatinine, oxalate, citrate, calcium, phosphorus, uric acid etc. In addition to specific treatment depending on kind of stone identified on testing, common measures that may help prevent recurrent stones include drinking plenty of fluids to keep urine output more than 2 litres/day, avoiding high salt and high protein diet etc.