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Kidney Diseases

Kidney pain and other symptoms.

10/10/2006

Question:

Hi, please can you give me some advice. I will give a brief medical history along with symptoms in the hope that you can help me. I am a 25yr old female.

I have a history of, Kidney stones in 2002 suspected IGA nephropathy from age 11 (biopsy was never done as it never cased pain) I was just monitered. My nephrologist wants to do biopsy after my ct scan Fibromyalgia IBS Pernicious anaemia restless legs syndrome.

My kidneys have not caused me pain until the kidney stones which it is assumed I passed. I have been experiencing pain in my kidneys for the last 6 months. The pain wakes me in the morning and subsides after urination, this is felt in both kidneys and is a throbbing pain. I have a dull throb throughout the day that comes and goes in each kidney alternating from left to right. I have been experiencing intense throbbing in right kidney and a sharp intermittent pain in both flanks alternating left and right. This sharp pain is never felt in both at the same time. The intense pain is simuler to the stones but not as severe. The throbbing painb can last for hours. I have mild nausea with the pain.

I have occasional stabbing bladdder pain in absence of infection, lasts for about 5 minutes and can knock me to the floor.

I brought some multi dipsticks and I have been testing 4 times a day. I always have the maximum leucocytes, erythrocytes (not haemolysed) protien that comes and goes ranging from neg to +++ my ph is generally from 8 -9 and my urine is always negetive for nitrates. Everything else is also negetive.

My urine ranges from rusty colour, to almost white or cola colour. it rarely looks normal. My gp has sent 7 samples and there is never any growth on culture (sterile pyuria). My fingers and ankles intermittently swell but not a huge amount, just puffy rather than pitting.

I have frequent headaches and itching.

I have recently started to have intense flushing episodes. I have had 2 major ones that were mistaken for anyphalaxis and I have around 5 a day that are milder, with redness but no intense heat or dizzyness. Alcohol brings on flush also. Not sure if this is related, been happening for 3 weeks.

My nephrologist said that IGA nephrapthy wouldn`t cause this pain and he is not convinced that its stones. He has taken blood (not been notified of results) and he ordered a CT scan. I went for my scan and they told me I couldnt have it as my period was 1 day out of the 10 day rule. I have been sent home with dihydracodiene and diclofenic. I see my nephrologist on Wednesday but I can wait another month till my period`s due to have another scan as I`m in too much pain. I haven`t had a sexual relationship for 6 years so I can`t possibly be pregnant.

He did say that if there were no stones on CT then he would biopsy as the next step.

This is really getting me down, do you have any idea what could be causing this? What tests should I ask for? Could my fibromyalgia be misdiagnosed?

My thiroid, liver function and CBC, CRP, tests are normal, awaiting kidney function test results. I had an auto antibody screen last year which was negetive but they did not do specific tests further. Could lupus be a contender here?

If I have kidney stones, would I feel them when they are in my kidney? when I had them before I only felt them when it was near my groin.

Blood pressure is always normal or can drop to 90. I never have any fever nor burning when I urinate.

If urine is left to stand in container it sometimes has a residue simuler to oil in a puddle. If left for longer it congeals to what looks like bacon fat. This is never when it has protien in it.

Urine often has particles in it (not stones as they swirl up and then sink if container moved) and visible pus.

Pain in kidneys if I need to urinate but cannot get to the toilet straight away, throbbing pain on both sides. Not every time, but 50% of the time.

I am sorry that this is so long, do you have any suggestions?

Answer:

It is hard to know how to put all this info together, but it sounds like your nephrologist is doing a good job.  Here are a few thoughts:

In up to 30% of people with IgA nephropathy, "loin pain" (flank pain) is indeed well-described as a symptom.

Kidney stones (especially small ones) do not necessarily cause pain, unless they are blocking or irritating something, such as the ureter (the slender tube that connects each kidney with the bladder).  They should be easily detected on CT scan, however.

The blood, white cells, and protein in your urine are worrisome, and I completely agree with your nephrologist that you need a kidney biopsy.  You do not say whether your kidney function (waste-excreting ability) is normal, but it certainly sounds like there is potential for ongoing kidney damage, judging by your description of your urine findings.  So the sooner your kidney disorder can be identified (by biopsy) and treated, the more of your kidney function can be preserved.

It is unlikely that you have lupus, since your autoimmune screening tests and CRP were negative.  However, if the kidney biopsy shows features of lupus, it is possible to order other blood tests (that are specific for lupus and other autoimmune diseases) just to be sure.

I do not know what to make of your descriptions of your congealed urine.  Some people have a lot of phosphates in their urine, which do not signify any disease, but can cause the urine to look cloudy, and can appear as particles when the urine is allowed to stand, and especially when the urine pH is high, as yours is.  Microscopic exam should show phosphate crystals.

Your high urine pH's are puzzling -- most people have a urine pH of 5-6 all the time.  High urine pH can be caused by certain medications (such as Diamox, used to treat eye disorders), chronic urinary tract infections, vegetarian diets, and a disorder called RTA (or renal tubular acidosis), which your nephrologist should be able to detect with appropriate testing.

Your description of the flushing episodes is also interesting.  There are certain meds that can cause flushing (such as niacin, used to treat lipid disorders).  Pheochromocytoma (a rare tumor of the adrenals) can cause episodes of flushing, sweating, and hypertension; so can carcinoid tumors of the intestine.  Also, in case you are Asian: Asians frequently have a deficiency of the enzyme acetaldehyde dehydrogenase, which causes any alcohol that they drink to be turned into formaldehyde (resulting in symptoms such as flushing and a pounding headache).

Best of luck in getting to the bottom of your complicated problems -- I would be interested in hearing from you again when the diagnosis(es) is/are made!

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University