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Suggest Treatment For Right Flank Pain

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Posted on Thu, 24 Sep 2015
Question: Had protein in my urine for the past year. About 3 months ago presented with right flank pain radiating into my groin, thought it was a kidney stone. CT negative. 3weeks ago entered hospital for intense right flank pain radiating again into my groin. Cystogram and stent placed to see if it would help my pain. After stent removed developed excruating pain. Second cystogram showed a very swollen ureter and stent again placed and left for 1 week removed because I did not tolerate it. Nephroplexy performed to correct floating which was thought to be the cause of my problem. We'll 1 week post-op and still have severe flank pain which increases with urination. I have been in the hospital for 3 weeks. I keep telling my urologist my kidney feel like it's ripping. They can't seem to control my pain even though I am taking a lot of narcotics. I have had a lot of tests CT, nuclear Med Scan, renal ultrasound, showing Mild swelling after my first stent removal. I have been told I have some decrease kidney perfusion and function. Doctor can not explain why I still have severe pain. Since removal of second stent pain increases with urination. I'm. Desperate for answers,
doctor
Answered by Dr. Rakesh Madhyastha (2 hours later)
Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

Right flank pain could be due to other reasons as well. In order to help you I need a few more details

1. How is your renal function? Serum creatinine
2. Were there any cysts in the kidney?
3. Any pus cells in urine? any history of fever at all?
4. Why were the stent placed? Was there hydro uretero nephrosis?
5. Any kidney biopsy done?
6. Any history of diabetes?

Please get back to me,I am awaiting your reply

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha (35 hours later)
Thank you for reply, to your questions told my creating and BUN were normal. No cyst noted on CT or renal ultrasound. No history of puss in urine, no recent fever but do get chills and nite sweats. Nephrologist did do a TB test which was negative. No kidney biopsy, however my primary thought about it when protein was a year ago. Unfortunately she has left the practice and my new doctor felt that was to aggressive. No DM was worked up by a endocrinologist 6 years ago for fatigue and nite sweats was told everything was within the normal range. You asked why the stents? 1st stent apparently done because when cystogram done she noticed the kidney twisting and crimping the ureter. That stent was in for 2 day causing me more pain then when I was admitted. Had a foley placed day after stent with no relief of pain. No hydronephrosis noted before 1st stent, however about 48 hours after stent removed CT and renal US noted mild hydronephrosis. 2 more days passed with excurating pain and second cystogram showed the opening to ureter to be very swollen and about 1 inch of ureter normal and beyond that to be like a "sausage" that stent was in for a week then removed because of my pain. It's been out for 3 days and when I pee I get a sharp pain in my kidney, so they put a foley in. That has helped some with what they think might be reflux pain. I don't know what to do.....I am still in so much pain through the Right flank that gets worse when it wraps around the front and into the groin. Oh yea when they did the nephroplexy they also took out appendix, said it was full of stool. The surgeon who took out the appendix looked at post op CT and said all was good from her standpoint... Can't live like this, got to believe there is a real reason for my pain.
doctor
Answered by Dr. Rakesh Madhyastha (7 hours later)
Brief Answer:
Renal denervation

Detailed Answer:
Hello

Thanks for getting back in a detailed manner.

Here is what I think. Your case is truly puzzling, doctor have done a great job ruling out most causes of loin pain. It is indeed hard to treat without evidence any possible cause for the pain.
Here is what I would do if I were to be your doctor

1. The only other source of pain would be either the colon or the spine. I would get an MRI of the Spine done. I am guessing your stools are normal so I wouldn't investigate the colon
2. If the MRI is normal as well, I would treat in lines of nerve injury to the kidney.I would give a trial of Tab Pregabalin 75 mg twice daily for 8 weeks ( switching from gabapentin), this drug exclusively reduces pain arising due to nerves. If the pain still persists then I would ask the patient to undergo renal denervation for the chronic pain. Please speak to your doctor about my suggestion

I hope I was of help, if you have any further queries please get back to me

Regards

Such type of pain is best treated with opiods.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha (2 hours later)
Surgeon did denervation when he did nephroplexy. Will try lyrica, which he ordered. MRI 2 weeks ago was negative. Still wonder why I have tenderness with palpating. Also when pain escalates I have blood in urine....the pain is always there with waves of intensity. I will try your suggestion. Thanks.
doctor
Answered by Dr. Rakesh Madhyastha (20 hours later)
Brief Answer:
Hematuria loin pain syndrome

Detailed Answer:
Hello

I am sorry for the short delay in my reply, I was on call at my hospital and I just came back home

You can try lyrica however opioids are the mainstay of treatment if denervation has not worked. You can read more about hematuria loin pain syndrome here

https://en.wikipedia.org/wiki/Loin_pain_hematuria_syndrome#Treatment

Regards
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4364 Questions

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Suggest Treatment For Right Flank Pain

Brief Answer: Need more info Detailed Answer: Hello Thanks for the query Right flank pain could be due to other reasons as well. In order to help you I need a few more details 1. How is your renal function? Serum creatinine 2. Were there any cysts in the kidney? 3. Any pus cells in urine? any history of fever at all? 4. Why were the stent placed? Was there hydro uretero nephrosis? 5. Any kidney biopsy done? 6. Any history of diabetes? Please get back to me,I am awaiting your reply Regards