<s>[INST]My grown daughter (age 23) has had kidney stones for 5 years. She has passed many stones in those 5 years. This weekend she experienced the worst pains she has ever experienced. She began passing a white, think sandlike substance for several days She would experience horrible pain and pressure and then push and the substance would release in clumps. I am very worried about her . We have made an appointment at her urologist , but not expecting anything because they rarely have any answers for her. I was wondering if we should consider going to a nephrologist instead of a urologist. I am beginning to think we may be dealing with something in addition to kidney stones. Do you have any ideas of where we should turn at this point.[/INST]Welcome to Chat Doctor. It could be Chile(fat globules) or turbid urine. Urologist is the best person to see, not because I am one, but we are the ones to do surgical procedure if required. But there is no harm in seeing a nephrologist as well. She needs urinalysis, culture, urine for Chile, renal function tests and MVP/CT scan. Based on the results' treatment can be started. If pain is severe, obstruction can be relieved by a stent. Best regards Chat Doctor. </s>