About two years after having a simultaneous liver and kidney transplant, my urine test spiked with blood and protein. A few months (and corroborating tests) later this led to an ultrasound to see what was going on.

At least for me, I had spent so much time in the hospital that I was extremely comfortable, interested, and communicative when interacting with hospital staff, nurses, and doctors. So during the ultrasound I was chatting with the technician, and they repeatedly referred to my two original kidneys as “native”. They also repeatedly referred to the new kidney as the “transplant” kidney but that isn’t the obvious counterpart to “native”: the obvious (and appropriately suggestive) term would be “immigrant”.

I have two kidneys that lived in my body since birth and these are my native kidneys. I have one kidney that lived in someone else’s body for a long time but then migrated (due to unfortunate circumstances) to my body, so that is “obviously” an immigrant kidney. Amusingly, the immigrant kidney does all the work in my body and the two native kidneys just hang out and drink some water all day long.

Unfortunately, the immigrant kidney developed a huge (1.2 cm) stone in the two years it did all that work. The true cause is unclear at this point, but the stone was there and it was not coming out through any normal means.

Immigrants kidneys don’t complain

I had a significant kidney stone causing bodily havoc for many months. At no point during that time did my kidney directly cause me any pain. Until the blood test, I had no idea anything was wrong. After the blood test, I sporadically had weird pains in my shoulder and elbow that had no cause and would move around when interacted with. The nerves for a transplanted kidney are not reattached at the time of the transplant. They may eventually grow back but apparently had not sufficiently in my case for me to feel any pain from the giant stone trying to get out.

Immigrant kidneys live in unusual locations

Kidney transplants add a kidney into a new location in the patient’s body, they don’t replace an existing kidney. In my case, the new kidney is in my right-hip abdominal pocket [hah], which is pretty standard.

When discussing trying to get the stone out of the immigrant kidney, it became obvious that two normal kidney stone treatments would not work because of the unusual immigrant kidney location. These normal treatments are:

  • Extracorporeal Shock Wave Lithotripsy (ESWL)
  • Ureteroscopy (URS)

The first (ESWL) sends shock waves at the kidney stone and this can break it up into pieces that are small enough to work their way out through the ureter. But the right-hip pocket is located inside a big-bone (the hip) so sending shock waves at the kidney will mostly shake up the insides of your bones. Apparently that isn’t a pleasant experience and is ineffective in breaking up the kidney stone.

The second (URS) uses a ‘ureteroscope’ (long, thin tube) to snake up into the kidney starting from the obvious access point. The doctor can then examine and break up the stone. Although this procedure may not feel pleasant, the path is actually pretty straight from the access point and so directing the ureteroscope to the kidney is straightforward [hah]. But again the immigrant kidney lives in a different part of town and there is a serious lateral detour which is not simple to follow or to work with when the kidney is reached.

So these common and relatively simple outpatient procedures do not work well or at all with an immigrant kidney.

Accessing an eccentric location

The next level up to getting access to a kidney is to burrow an access hole (formally called ‘catheterizing’) to the kidney and then use that pathway for the same tubal access (now called a ‘nephroscope’). This procedure is called Percutaneous Nephrolithotomy (PCNL) and is an overnight procedure vs. the outpaitient procedures described above.

Compared to spending a month enjoying the spa-like M5 and ICU units of Stanford, and another week in M5 for the transplant, this one-overnight stay was unusually brief. I mostly hung out listening to “Murder, She Wrote” because the next bed over had it blaring all night long. Actually I have a lot of noise-canceling devices, so the insights of Jessica Fletcher could be tuned in and out as I wished.

The actual procedures were straightforward: Stanford has very good staff, nurses, and doctors, and strong policies for informing patients. And I extensively prepared to ask astute questions by watching a lot of episodes of “The Pitt”.

The summary of the two procedures is that they:

  • bored a hole,
  • went in with a tube to look around,
  • aimed a laser at the stone,
  • broke it up,
  • vacuumed the larger fragments out, and
  • left a stent in the ureter, in case it got stressed out about the whole experience.

I know about the laser part mostly because I asked why I needed to be anesthetized (general). The explanation “you might move while we shoot a laser at you” convinced me they were probably right.

Final Status

A couple of weeks later they removed the stent and we are now doing tests to determine how not to inflict me with more “Murder, She Wrote” in the future.