Q: My right kidney shows grade I-II hydronephrosis with two big calculi one measuring - 21mm in pelvis and other 09 mm in mid calyx. Lower pole of both the kidneys are fused (Horse shoe kidneys). Left kidney is normal. The right kidney is decreased in size and globular in shape and the GFR is 2.7 and pelvis is dilated. Kindly suggest some different conservative as well as surgical measures.

A:Because of the fact you have horse shoe kidneys, you are susceptible to stone disease. The stones in your right kidney are obstructing the urinary tract and deserve immediate attention for the lack of it would only propagate the ongoing damage. Possible options include endoscopic removal of stone and temporary stent placement. Lithotripsy may not be advisable until the obstruction is relieved. Other more invasive surgical procedures are unnecessary at this time since less invasive endoscopic options are well tested and fairly successful. The next would be to determine the cause of stones and preventing them from recurrence. This can be done after stone is retrieved and sent for stone analysis. Other precautions would include generous fluid intake, maintain daily urine output more than 2.0 L/day. Observing stone diet which I have described in great detail previously (and is archived in Q&A section) includes low sodium, low protein diet. Avoiding foods such as cabbage, lettuce, tomatoes, caffeine etc. You doctor should also order 24 hour urine sodium, calcium, phosphorus, uric acid and citrate, serum calcium, phosphorus, PTH etc. Taking potassium citrate tablets also helps but I cannot advise since I do not have your blood tests and urine studies.