About 10 years ago my ex-husband, who has always been in good health, developed hematuria. There was no work up then. About 3 years ago, he developed multiple kidney stones in only the left kidney. He has also experienced multiple episodes of gout. His left kidney has atrophied to 6mm transverse x 8mm AP x 9mm sup-inf-inf. He is on Potassium Citrate 3x daily with Allopurinol. He had shock wave lithotripsy 08/16 with questionable results. A renal US in 11/16 noted again multiple kidneys stones with further atrophy. He has had several more gout attacks with this regime. GFR is 41. I am concerned about damage to kidney from persistent good sized stones. Should they be removed? Would a biopsy be warranted? Why are there stones in only the one kidney? Could it progress to involve the other? There is no family history of kidney disease or gout. Thank you for your help.

The problem that you raise is a urological problem and should be dealt with by a urologist.  I am a nephrologist and have no experience with lithotripsy or surgery.  I suggest that your ex-husband consult with a urologist and determine the best course of action.  The left kidney is extremely small and may not be functional.  The decision to perform surgery must be made by a urologist.

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