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Urinary Disorders

Right Flank Pain and Blood in Urine

11/28/2006

Question:

Over 2 years ago my son had micro blood in his urine. Bladder scope was normal and nothing more was done. Soon afterwards he started complaining of intermittent right flank pain and pain into his back under the rib cage. His pain has steadily increased. An IVP indicated that the top of the right kidney is not draining properly when he is laying down, but should drain when he stands up. They tried 2 stents, but these did not help because there is no stricter or closure. Pain is still increasing in severity. The blood in his urine has increased from micro to moderate. Last urine test also noted a trace of protein. He has gastritis as a result of thepain. Weight loss, stomach aches, and trouble sleeping are other symptoms. Because the urologists aren`t sure the kidney is causing all this pain, he is scheduled for a laproscopy tomorrow to have his liver, pancreas, bile ducts, etc...looked into.

Any advice or suggestions is appreciated.

Answer:

Tomorrow is short notice and presumably your son has undergone a CT scan prior to exploratory surgery.

Your description of "the top of the right kidney is not draining properly when he is laying down" suggests that the top and the bottom of the kidney are different which happens occasionally when the kidney's ureter is duplicated. This situation offers the possibility of reflux (back up of urine into the upper system) or obstruction due to ureteropelvic junction obstruction or dysplastic kidney. Besides the IVP, you might discuss the benefits of a CT urogram or a lasix renal scan with your urologist(s). Consultation with a pediatric urologist may be helpful to review possible congenital abnormalities which have delayed presentation (you do not indicate your sons age).

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati