Suggest Treatment For Left Sided Lower Back Pain

Posted on Sat, 5 Apr 2014

Question: Dear Doctor - This is with regards to my mother who is 70 years old , Diabetic , Hypertensive & a heart patient (CABG,Angioplasty) . Last year she was admitted in admitted in hospital for cellulitis , at the time of discharge her Creatinine was 1.7. On 21st Feb when her renal profile was done , serum creatinine was 3.4 . Her Urine Culture was done , and as she had infection doctor has recommended Levoflox 500 for 2 weeks + regular Frusenex (1-1-0) . Since last 4 days , she is getting excruciating pain on her lower back (left side) . She takes SOS ULTRACET and hot water fomentation , which is not helping . Can you please advice what should she take for strange left side pain . Due to her sedentary lifestyle , she rarely goes out of the house as it also takes a toll on her body (palpitation) + overall body pain . she undergoes physiotherapy thrice week though. Please do advice 1) What medicine should be taken for her lower back left shooting pain ( exactly near lower HIP side) ? 2) What should be a safe protein she can introduce in her diet and how many grams /day ? 3) I am planning to repeat her CBC,Serum Creatinine this week , any other tests to get better picture on her Renal Profile ? thanks and regards XXXX

Answered by Dr. Ravi Bansal (1 hour later)

Brief Answer: Diabetic with UTI and acute on CRF Detailed Answer: She is suffering from DM , Diabetic nephropathy and UTI. The pain can be because of Pyelonephritis or bone weakness like osteoporosis. You need to do a ct KUB under guidance of your doctor to confirm the diagnosis. She can take veg protein and eggs upto 42 gm protein /day. You can make a diet chart prepared by a nutritionist with these options. Discuss with the treating doctor before implementing it. you can also get urine routine to see if puss cells ( WBC ) are reducing to see if the infection is getting controlled. Also check calcium phosphorus and uric acid. Please inform the reports. best wishes.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ravi Bansal (48 hours later)

Dear Doc , In continuation I had some other questions , which will help me understand the RISK around my mom's health better . What is that value of SERUM CREATININE , which is considered as ALARMING and for which DIALYSIS is considered as an only option ? (Her last reported values are 1.7 , 3.4) What are the pre-requisite for a son to donate kidney to his mother (in my case) , to qualify as a ORGAN DONOR ? I am extremely concerned about her : 1) Lethargy 2) Poor Apetite 3) Excruciating pain on the left side of back (lower hip) - Any renal safe painkiller other than ULTRACET which currently takes as SOS ? I will be sharing her RENAL PROFILE report again with you . I don't want to take any decision which is detrimental in improving her health condition and at the same time do not wish to press the PANIC button. Please do help me understand this queries so that I can take necessary action. Thanking you for your time.

Answered by Dr. Ravi Bansal (10 hours later)

Brief Answer: UTI and Pain Detailed Answer: Hi XXXXXXX along with renal profile it would be very important if you could get urine routine and microscopy, and blood TLC and also inform me the ultrasound or CT scan report ( if done). Dialysis is generally needed at around 6 to 7 mg/dl serum creatinine but it also depends on the amount of swelling ,patients apatite and any breathlessness. So the treating doctor is the best judge. Since she has a infective pathology and acute kidney disease she is not a candidate for transplant. So discussing ORGAN DONATION is beyond the scope of present case. Cause of excruciating pain is not clear. Kidney conditions rarely cause such pain- again a CT scan or ultrasound report is a must to comment further. There is no need to panic . discuss these points with your treating doctor. best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (11 hours later)

Dear Doctor - Thankfully her creatinine has settled , uploading the report for your reference . Pain currently is being managed by ULTRACET (SOS) , but cause is still unknown . Do let me know in case of any other course of action. Thanking you doctor.

Answered by Dr. Ravi Bansal (3 days later)

Brief Answer: UTI Detailed Answer: Hello XXXXXXX sorry i could not reply earlier, i was travelling. Reports are normal now only mild renal dysfunction. urine and blood do not show any infection. i think you just have to complete the full course of antibiotics. Best wishes.

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar