Brief Answer:
Possible pyelonephritis (flank pain + fever)

Detailed Answer:
Hello and welcome,

The combination of pain in the kidney area plus a fever can mean a kidney infection. And kidney stones can increase the risk of infection, although it isn't necessary for there to be a stone to have a kidney infection.

I don't know if you had a fever when you went into the ER, but at this point, you may need an antibiotic. While uncomplicated bladder infections can be treated with increased water and cranberry juice, when there is also fever and flank pain, then it is time for an antibiotic.

Please go back to see a doctor (urgent care clinic would be fine) and give a urine specimen. This should be sent to a lab for both a culture and antibiotic sensitivity test. And an antibiotic should then be started.

If they haven't already taken an X-ray or other imaging studies to look for a stone, they should do this to.

Please let me know how you are doing after you are evaluated.

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Brief Answer:
How was the infection treated?

Detailed Answer:
Have you been on an antibiotic for the infection? Which antibiotic, and for how many days? And was the urine sent for a culture and sensitivity test?

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Brief Answer:
Thoughts about what might be going on:

Detailed Answer:
Without knowing all of the information your doctor had access to, some of my thoughts are:

The infecting bacteria may have only been partially sensitive to the Ceftin (meaning also partly resistant). When this happens, an infection can continue in a low grade way and not always show up on subsequent urinalyses (until it gets quite bad again). That's why I asked about a culture and sensitivity test. When we get a urine specimen that shows bacteria, and a person has symptoms of pyelonephritis, we don't wait for culture results - we start an antibiotic right away (as was appropriately done). But at the same time, we send the initial urine specimen (before treatment) for both a culture (to identify the bacteria) and sensitivity - where a list of antibiotics are tested against that grown bacteria to see if the bacteria is sensitive to each or not. Sometimes bacteria are only partially or incompletely sensitive, which means that the antibiotic might help but not enough.

I suggest going in or calling the place that the initial urinalysis was done and asking if a culture was done, and if so, for them to look at the sensitivity report.

Given that you have a fever, I think you need to be reevaluated, especially if you were without a fever after the antibiotic briefly.

And imaging studies would be appropriate if the pain has not changed. There might be a reason that either an infection has restarted or persisted - stones, cysts, etc. A renal ultrasound can help provide more information and is a wise idea at this point especially since you have a history of stones and your pain feels like when you've had stones in the past.

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Brief Answer:
Doubt muscular.

Detailed Answer:
I doubt that it is muscular pain. Muscular pain would increase with use of the muscle. Given that you had a urinary tract infection, and have a fever, I think it is an internal problem.

Glad that you are having a scan tomorrow.

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Brief Answer:
Some thoughts on this.

Detailed Answer:
Are you still having fevers though?

It's possible for stones to show up on CT scans and not ultrasound.

Any "casts" seen in the urinalysis?

I imagine you know to drink copious amounts of water if there is suspicion of a stone.

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Brief Answer:
Time to talk with a urologist.

Detailed Answer:
To tell you the truth, I don't know at this point. But I can make 2 recommendations:

1. Call today to have referral to urologist rather than waiting to see your family doctor. It can take awhile to get in to see one so the sooner you or your doctor's office calls for an appointment the better. You can call your doctor's nurse and ask if she/he can make the appointment now.

2. With this new information (the urinary retention quantity, the recommendation for CT, the normal gynecological exam), post a new question on this site and write at the beginning of the first line: "FOR UROLOGIST ONLY".

A urologist will respond - most likely later today or tonight. Be very detailed in the history you provide and your question so he or she can be able to provide more information.

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