Most people with cystinuria experience recurrent episodes of kidney stones, usually more than one per year. This can lead to a number of effects that have a noticeable impact on their quality of life and affect the appropriate management of the condition.
While the overall prognosis of cystinuria is positive, there are several complications of the condition that can have severe repercussions. It is important that patients have an understanding of possible complications and the early warning signs of these to enable them to seek timely medical management.
Renal colic is a condition that involves moderate to severe pain, as a result of the movement of a kidney stone moving down the ureter towards the bladder.
This pain is usually reported in the lower back and is commonly concentrated to one side – as the stone is moving down a ureter on one side. It begins in the lower back and progresses down towards the groin as the stone moves.
Recurrent Urinary Tract Infections
Individuals affected by cystinuria are more likely to suffer from infections of the urinary tract than members of the general population. Symptoms of a urinary tract infection (UTI) include:
- Frequent urge to pass urine
- Pain or burning on urination
- Cloudy urine with pungent smell
- Back pain
In severe cases when the infection has spread beyond the bladder and into the kidneys can lead to more symptoms, including fever, nausea and vomiting.
Hydronephrosis involves a blockage of the ureter, usually as a result of a stone lodged in the area, and causes the urine to flow back up into the kidney. This affects the function of the kidney, as the organ becomes enlarged and the area is also prone to infection.
Signs of hydronephrosis may include:
- Abdominal pain
- Increased frequency of urination
- Pain on urination
- Nausea and vomiting
While the kidneys can often regain previous function with the removal of the stone blocking the ureter, in rare cases the kidney function can be irreversibly changed.
Damage to the urinary tract can lead to recurrent infections and blockages in the area and may require reparative surgery, which can also cause scar tissue. Over time, this can lead to renal insufficiency or renal disease.
Management of Complications
It is essential that complications of cystinuria are adequately managed as soon as possible to prevent further damage to the renal system.
This process involves early detection with regular tests to monitor the function of the kidneys and detect any damages. A physical examination can be used to check for enlargement of organs and a laboratory urine examination is helpful to test the concentration of substances in the urine.
In some cases, diagnostic imaging may be used to gain insight into the extent of swelling and the area of the renal system that is likely to be affected by the blockage. An ultrasound or computed tomography (CT) scan may be useful for this purpose.
A catheter can help to drain some of the fluid from the renal tract and remove any obstruction that may be causing symptoms. Depending on the specific nature of the complication the management plan will differ, but may include treatment with antibiotics of insertion of a urinary stent or nephrostomy tube.