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What Causes Discomfort In The Flank Despite A Normal Kidney Report?
Question: Hello doc
Apologies for a long history. I had a mild flank discomfort from past 3 months (since June) but no diagnosis as yet, need your expert help/opinion. Here is the summary
My History: My mother says I was given 30-40 injections when I was 3-4 years old due to urine infection, nothing more than that she remembers. I have been well with no issues till 2008. But I had some episodes of reflux in last 5-7 years and sudden pain in flank side when bladder pressure was high and I get some obstruction (like my underwear hitting the flow or delay in urinating).
The real problem starts here:
End May: Mild discomfort started in left flank. I went for abdominal ultrasound and have attached the report. Everything came ok expect kidney. KFT came normal and S cretanine was 1.08. Did a urine test and everything came normal. Went to an Urologist and he suggested it could be CKD and to go for CT Kidneys. Repeated my S Creatanine and it came 1.14.
July 1st week: Went for CT and attached report showed minor non obstructive stone (2mm) and scarring and cortical thinning + dilated kidneys. Went for a Urine culture and it came negative. Kept my S Creatinine checking and it was 1.14 average.
Aug: After the CT, Pain was on and off flank/back for a month with complete respite for almost a week. Initially I used to feel pain/discomfort when I used to sit otherwise not but then it used to come and go. I thought it is stone and since my cretanine is normal let me not do anything further and give it time to pass.
Last week: But Since last week pain started again and this time decent pain for 2 continuous days more in back than flank and frequent urge for urination. Also felt weakness in legs. So did the repeat KFT, Urine test and culture again and went to doctor. KFT showed high Uric acid but S Cretanine was 1.14 . Urine test report shows Protien 1+. Urine Protein/Creatinine ratio 0.28. Electrolytes within range & normal. I & doc thought might be UTI so he suggested to take antibiotics (Taxim o 200mg) for a week. Also taking Alfoo + Drotin Ds (SOS pain) + Febutaz 40(once daily) + uriliser(twice). But surprisingly my culture report came as negative. Although I am still continuing with Taxim thinking UTI might have been missed during testing but not sure.
22-Aug Had an episode of severe headache at night time(9:00-11:00 PM) followed by sudden heart palpitation and feeling of dizziness while urinating at midnight, almost like i would faint. Checked my heart rate and it was around 95-100 at that time. I had taken Drotin Ds that day at 4:00 PM so not sure if it was a side-effect. Pain reduced post this episode but sometimes I feel a dull pain (feeling of injury) around back kidney side. Not frequent urination but still minor difficulty at times.
I am completely lost on what it could be and not sure which test I should go further but doctor has advised dynamic renal scan. I would like you to kindly share your opinion on my case. Please help & advise if you can sense what could be the problem or if dynamic renal scan will be able to confirm what is the problem. Does it appear UTI/stone or obstruction? Any other test or advise you would like to provide, please help.
Apologies for a long history. I had a mild flank discomfort from past 3 months (since June) but no diagnosis as yet, need your expert help/opinion. Here is the summary
My History: My mother says I was given 30-40 injections when I was 3-4 years old due to urine infection, nothing more than that she remembers. I have been well with no issues till 2008. But I had some episodes of reflux in last 5-7 years and sudden pain in flank side when bladder pressure was high and I get some obstruction (like my underwear hitting the flow or delay in urinating).
The real problem starts here:
End May: Mild discomfort started in left flank. I went for abdominal ultrasound and have attached the report. Everything came ok expect kidney. KFT came normal and S cretanine was 1.08. Did a urine test and everything came normal. Went to an Urologist and he suggested it could be CKD and to go for CT Kidneys. Repeated my S Creatanine and it came 1.14.
July 1st week: Went for CT and attached report showed minor non obstructive stone (2mm) and scarring and cortical thinning + dilated kidneys. Went for a Urine culture and it came negative. Kept my S Creatinine checking and it was 1.14 average.
Aug: After the CT, Pain was on and off flank/back for a month with complete respite for almost a week. Initially I used to feel pain/discomfort when I used to sit otherwise not but then it used to come and go. I thought it is stone and since my cretanine is normal let me not do anything further and give it time to pass.
Last week: But Since last week pain started again and this time decent pain for 2 continuous days more in back than flank and frequent urge for urination. Also felt weakness in legs. So did the repeat KFT, Urine test and culture again and went to doctor. KFT showed high Uric acid but S Cretanine was 1.14 . Urine test report shows Protien 1+. Urine Protein/Creatinine ratio 0.28. Electrolytes within range & normal. I & doc thought might be UTI so he suggested to take antibiotics (Taxim o 200mg) for a week. Also taking Alfoo + Drotin Ds (SOS pain) + Febutaz 40(once daily) + uriliser(twice). But surprisingly my culture report came as negative. Although I am still continuing with Taxim thinking UTI might have been missed during testing but not sure.
22-Aug Had an episode of severe headache at night time(9:00-11:00 PM) followed by sudden heart palpitation and feeling of dizziness while urinating at midnight, almost like i would faint. Checked my heart rate and it was around 95-100 at that time. I had taken Drotin Ds that day at 4:00 PM so not sure if it was a side-effect. Pain reduced post this episode but sometimes I feel a dull pain (feeling of injury) around back kidney side. Not frequent urination but still minor difficulty at times.
I am completely lost on what it could be and not sure which test I should go further but doctor has advised dynamic renal scan. I would like you to kindly share your opinion on my case. Please help & advise if you can sense what could be the problem or if dynamic renal scan will be able to confirm what is the problem. Does it appear UTI/stone or obstruction? Any other test or advise you would like to provide, please help.
Brief Answer:
Possibility of reflux is high.
Detailed Answer:
Hello XXXX and welcome to HCM.
As an Urologist,i can understand your concern.
XXXX,your CT-IVU clearly shows both kidneys,have thin cortex.(more on right)
The stone is too small to cause any symptom.
Scarring in kidneys,is due to chronic urinary infections.
That's why you must've been given injections in childhood.
A dynamic isotope scan is done to know function in each kidney.
You also need to do a Cystogram,to rule out a VUR( reflux ).
The CT scan is suggestive of urine going back into the kidneys,called reflux.
These two test reports together,will give an idea,about further treatment.
You're lucky to have creatinine (kidney function ) in normal levels.
Reply with uric acid and scan reports,for an expert opinion.
Wish you well.
Dr.Matthew J. Mangat.
Possibility of reflux is high.
Detailed Answer:
Hello XXXX and welcome to HCM.
As an Urologist,i can understand your concern.
XXXX,your CT-IVU clearly shows both kidneys,have thin cortex.(more on right)
The stone is too small to cause any symptom.
Scarring in kidneys,is due to chronic urinary infections.
That's why you must've been given injections in childhood.
A dynamic isotope scan is done to know function in each kidney.
You also need to do a Cystogram,to rule out a VUR( reflux ).
The CT scan is suggestive of urine going back into the kidneys,called reflux.
These two test reports together,will give an idea,about further treatment.
You're lucky to have creatinine (kidney function ) in normal levels.
Reply with uric acid and scan reports,for an expert opinion.
Wish you well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr XXXXXXX
Thanks for your reply. Is it possible that the earlier reflux painful episodes(7-8) I mentioned might have caused the scarring?
Now I ensure that I urinate as often as possible. Are there still chances or reflux if let's say I pass urine every 30 mins-1 hour?
Also My father just underwent treatment for cancer. So I don't want to take too much radiation considering the risk that my genes might carry the risk? I have already undergone CT so is Dynamic scan & cystogram ok from an radiation point of view?
And incase we find refux, what will be the solution, is it surgery only or if i urinate too often I can prevent further damage to kidneys? Or is it that if I don't undergo surgery etc, it will continue causing damage to kidneys no matter what?
Can reflux cause this sudden pain and issues that I am going through currently or do you think this is more of UTI episode?
Also have attached KFT report. Thanks
Thanks for your reply. Is it possible that the earlier reflux painful episodes(7-8) I mentioned might have caused the scarring?
Now I ensure that I urinate as often as possible. Are there still chances or reflux if let's say I pass urine every 30 mins-1 hour?
Also My father just underwent treatment for cancer. So I don't want to take too much radiation considering the risk that my genes might carry the risk? I have already undergone CT so is Dynamic scan & cystogram ok from an radiation point of view?
And incase we find refux, what will be the solution, is it surgery only or if i urinate too often I can prevent further damage to kidneys? Or is it that if I don't undergo surgery etc, it will continue causing damage to kidneys no matter what?
Can reflux cause this sudden pain and issues that I am going through currently or do you think this is more of UTI episode?
Also have attached KFT report. Thanks
Brief Answer:
Isotope studies have very minimal radiation. No fear of cancer.
Detailed Answer:
Hi XXXXX,
Actually the renogram has minimal radiation.
The cystogram can also be done,using isotope study.
Your Urologist can get it done that arranged.
Let the reports come and accordingly,further treatment can be advised.
Your blood reports,show high uric acid levels.
You're already on Febutaz for that.
VUR is graded and depending on severity of it,treatment is advised.
That grade can be made after seeing the reports.
Corrective surgery is always done, to prevent further deterioration of function.
That way the kidney function is preserved.
Wish you well.
Dr.Matthew J. Mangat.
Isotope studies have very minimal radiation. No fear of cancer.
Detailed Answer:
Hi XXXXX,
Actually the renogram has minimal radiation.
The cystogram can also be done,using isotope study.
Your Urologist can get it done that arranged.
Let the reports come and accordingly,further treatment can be advised.
Your blood reports,show high uric acid levels.
You're already on Febutaz for that.
VUR is graded and depending on severity of it,treatment is advised.
That grade can be made after seeing the reports.
Corrective surgery is always done, to prevent further deterioration of function.
That way the kidney function is preserved.
Wish you well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Dr XXXXXXX
I went for the scan today. Attached are the reports.
Is the GFR value used to calculate Kidney function 64.8? Am I stage 2 CKD as per it?
Could you please interpret the report for me and also future course of action. Is this is a reversible condition? And can i prevent further damage? Thanks
Regards
XXXX
I went for the scan today. Attached are the reports.
Is the GFR value used to calculate Kidney function 64.8? Am I stage 2 CKD as per it?
Could you please interpret the report for me and also future course of action. Is this is a reversible condition? And can i prevent further damage? Thanks
Regards
XXXX
Brief Answer:
Isotope scan shows reduced kidney function on both sides.
Detailed Answer:
Hi XXXXX,
GFR does indicate the kidney function.
This scan shows decreased function in both the kidneys. right more than left.
Now you need to do the other tests,as written in my previous reply.
After seeing them,i can give you an expert opinion.
Wish you good health.
Dr.Matthew J. Mangat.
Isotope scan shows reduced kidney function on both sides.
Detailed Answer:
Hi XXXXX,
GFR does indicate the kidney function.
This scan shows decreased function in both the kidneys. right more than left.
Now you need to do the other tests,as written in my previous reply.
After seeing them,i can give you an expert opinion.
Wish you good health.
Dr.Matthew J. Mangat.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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