How to treat a kidney damaged due to chronic pyelonephritis?

Dr Ashutosh Singh
Consultant Nephrologist,
Knoxville,
USA

Q: I am 65 years old and was installed with a permanent pacemaker in 2000. (Type SD 303, Mfg Medtronic Type 5592-53cm) I have osteoarthritis for the last 20 years. My legs and ankles are swollen and I have pain too. I also have a stone in the ureter. Ureterolithotomy was done under general anaesthesia. Recent ultrasound of whole abdomen suggests that the right smaller kidney with scarring upper pole and dilatation of pelvicalyceal system, especially upper calyx is suggestive of chronic pyelonephritis. Recent blood test have suggested Hb - 12.5; S Creatinine - 1; Blood sugar (Routine) - 89; Calcium - 9.5; Phosphorous - 4; Alkaline phosphate - 106; serum cholesterol - 179; TSH - 2.63. What is the treatment required for the kidneys?

A:A review of the information provided suggests that your right kidney has been irreversibly damaged by the recurrent or persistent kidney infection (chronic pyelonephritis). However, your serum creatinine of 1.2 mg/dL indicates that you have a relatively preserved kidney function, which probably is being accounted for by your left kidney. Any treatment should focus on the risk factors responsible for the worsening of chronic kidney disease including

Strict blood pressure control (if hypertensive)

Avoiding all potential kidney toxic medications that include non-steroidal anti-inflammatory pain medications like Voveran, Brufen & Nimulid, the consumption of which should be avoided especially on a continuous basis.