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Kidney Diseases

Dull pain in left flank

05/30/2008

Question:

I am a physically fit, 34 year-old female. I have had intermittent, dull, low-grade pain/discomfort in my left flank starting in January 2008 (for about 5 months now). Sometimes I feel the pain on my front, sometimes in the back side. In August 2007, I had a prolonged UTI which also caused me (intense) pain in the same area. Two urologists have told me that I no longer have an infection or hematuria. I have had ultrasounds and an X-ray with iodine contrast. A gynecologist also told me that I was fine. The pain is not stimulated by any kind of physical movement. Should I ask for more sophisticated imaging, or should I see another physician? If so, what kind? I would like to start having children, but I think I need to resolve my kidney/flank pain first. I thank you for your response!

Answer:

It is difficult to answer your question without having a little more information.  I think that you should definitely see another doctor, preferably an internist or your family doctor.  After a careful history, physical exam, and review of your lab tests and imaging studies, the doctor should be able to advise you whether you need to see a nephrologist (a medical, nonsurgical kidney specialist).  The information that your doctor will need to put together in order to decide whether you have a kidney problem will include answers to the following questions:

When you had your UTI in 8/07, was it pyelonephritis (i.e., was it an actual infection of the left kidney)?  Or was it simply a bladder infection?  If it was only a bladder infection, then it would not account for the pain that you are experiencing.

What have your recent urine analyses shown?  Has your urine contained any protein or blood?  How about white blood cells or bacteria?  Have you had a urine culture?  If so, have any bacteria grown in it?  If all of those tests were negative, again your pain is unlikely to be from your kidney.

Have you had blood tests to evaluate your kidney function?  Is it normal?

Have any of the imaging studies been abnormal in any way?  How recently were they done?  Have you had one since the UTI of 8/07?

If no abnormalities are found on any of the above tests, then it is unlikely that you have a kidney problem.  If abnormalities (even small ones) were noted and no imaging has been done since 8/07, it would probably be worthwhile repeating either an ultrasound or an IVP.  But the best determination can undoubtedly be made by a doctor for whom you can point to your side and say, "The pain is right HERE."  The exact location should allow the doctor to immediately determine whether it's possibly from the kidney, or  whether it's in a non-kidney location.  A careful detailed description of your pain in your own words will also be very helpful and should allow the doctor to determine whether the kidney is likely to be involved.  Good luck, and I hope you get a definitive answer soon!  

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Response by:

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