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What Causes Left Flank Pain With Pain In Abdomen, Back And Shoulder?
Question: I have pain, left flank, abdomen and back/shoulder. I have left parapelvic cysts, first at just 2mm in 2010 and grew to 4.8 by 2.5 cm by Nov 2012. Pain started about Feb 2013 and grew worse with spasms and have been to emergency several times with this pain, where they said maybe partial bowel blockage or maybe kidney cyst is the cause of pain. I had long been on low dose Lorazapan, and had increased the dosage, and then backed off, so possible muscle tension issues, so gradually went off that completely, for a year now.
Pain was accompanied with very high blood pressure and left arm restriction. By XXXXXXX 2015 B/P stayed high, sometimes to emergency levels, then by XXXXXXX I had swelling in abdomen, and shortage of breath, and I had left bowel infection and blockage and swelling on prostate. GP put me on antibiotics for 6 weeks, and I went on liquid diet for a month and reduced salt and red meat. Blood pressure dropped really low and I gave up B/P med. I am waiting for a scope bowel exam, and my breathing is good. But little change in by left pain. I saw a urologist in Feb who said my pain was too diffuse to be caused by the cyst, and said there was no need for further images. I saw a nephrologist a month ago, but he could not comment on pain, only on EGFR.
In XXXXXXX 2014, my first ER visit, it showed up I had stage 3 CKD. Creatitine up some at about 120 and EGFR at about 55 for about 1.5 years (from XXXXXXX 2014 to July 2015). But since July EGFR is above 60 and Creatinine about 95, so significant kidney improvement.
As pain persists, and seems more concentrated in left kidney area, but in other areas mentioned, I am concerned about the cyst. Scan in Feb 2014 implied it was stable at 4.8 cm but gave no second dimension. The second dimension of 2.5 cm was last noted in feb 2012, so now 3 years ago. I have had two recent scans, enhanced CT and MRI and they do not state the dimensions, but doctors suggest it is stable. The last scan stated there are now a few of these cysts there. I asked my GP and the nephrologist if they could ask the radiologist for the present cyst size, but no luck,,,, the radiologist said it was not clinically significant! In the past month I am getting discomfort progressing, at times to my spine and right back, but still 95 percent left side. Nephrologist says it is strange that the radiologist will not state the size, but he will not ask himself, and suggests my GP ask. And the GP says the nephrologist could have asked, but he will try again. I would have some peace of mind if I had assurance this cyst has not grown, given my pain issues. This is long winded and you likely see my frustration. I would like a nephrologist reply. Thanks. XXXXXXX XXXXXXX
Pain was accompanied with very high blood pressure and left arm restriction. By XXXXXXX 2015 B/P stayed high, sometimes to emergency levels, then by XXXXXXX I had swelling in abdomen, and shortage of breath, and I had left bowel infection and blockage and swelling on prostate. GP put me on antibiotics for 6 weeks, and I went on liquid diet for a month and reduced salt and red meat. Blood pressure dropped really low and I gave up B/P med. I am waiting for a scope bowel exam, and my breathing is good. But little change in by left pain. I saw a urologist in Feb who said my pain was too diffuse to be caused by the cyst, and said there was no need for further images. I saw a nephrologist a month ago, but he could not comment on pain, only on EGFR.
In XXXXXXX 2014, my first ER visit, it showed up I had stage 3 CKD. Creatitine up some at about 120 and EGFR at about 55 for about 1.5 years (from XXXXXXX 2014 to July 2015). But since July EGFR is above 60 and Creatinine about 95, so significant kidney improvement.
As pain persists, and seems more concentrated in left kidney area, but in other areas mentioned, I am concerned about the cyst. Scan in Feb 2014 implied it was stable at 4.8 cm but gave no second dimension. The second dimension of 2.5 cm was last noted in feb 2012, so now 3 years ago. I have had two recent scans, enhanced CT and MRI and they do not state the dimensions, but doctors suggest it is stable. The last scan stated there are now a few of these cysts there. I asked my GP and the nephrologist if they could ask the radiologist for the present cyst size, but no luck,,,, the radiologist said it was not clinically significant! In the past month I am getting discomfort progressing, at times to my spine and right back, but still 95 percent left side. Nephrologist says it is strange that the radiologist will not state the size, but he will not ask himself, and suggests my GP ask. And the GP says the nephrologist could have asked, but he will try again. I would have some peace of mind if I had assurance this cyst has not grown, given my pain issues. This is long winded and you likely see my frustration. I would like a nephrologist reply. Thanks. XXXXXXX XXXXXXX
Brief Answer:
Be assured that the size of the cyst does not bear clinical significance.
Detailed Answer:
Thanks for asking on Healthcaremagic.
I have very carefully gone through the entire details mentioned. Let me assure you that the size of the cyst is not a cause of concern. What is more concerning is the present stage of your CKD. The cyst is not a source of your problems, rather, it is likely to be a sequele of the underlying damaging parameter which has landed your kidney in the present stage of chronic kidney disease. I understand that the radiologist has not specified the size of the cyst but irrespective of whether the size has reduced, remained the same or even increased in size, it does not have a clilnical significance. The pain is likely to be due to a renal colic which could be due to the spasm of the ureters.
If you are still apprehensive, please upload the report, both previous and present, and I would be happy to help you further.
Regards
Be assured that the size of the cyst does not bear clinical significance.
Detailed Answer:
Thanks for asking on Healthcaremagic.
I have very carefully gone through the entire details mentioned. Let me assure you that the size of the cyst is not a cause of concern. What is more concerning is the present stage of your CKD. The cyst is not a source of your problems, rather, it is likely to be a sequele of the underlying damaging parameter which has landed your kidney in the present stage of chronic kidney disease. I understand that the radiologist has not specified the size of the cyst but irrespective of whether the size has reduced, remained the same or even increased in size, it does not have a clilnical significance. The pain is likely to be due to a renal colic which could be due to the spasm of the ureters.
If you are still apprehensive, please upload the report, both previous and present, and I would be happy to help you further.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Just a test , as my follow up question disappeared
Dr. Saha
Your suggestion of kidney stones seems to fit my symptoms: I have constant pain that is level 3 or 4 out of 10, goes to 5, agony level, and at times 8 or 9 which sends me to ED, Emergency. I cannot sit up right, only a few minutes whereby pain and BP rises, and very difficult to drive a vehicle, and only by inclining the seat to about 45 degrees and still very painful. I sleep on my right side only for a long time, but this improved a little bit. I eat most of my meal standing. When I visit a doctor I remain standing.
At present my BP goes very low when I lie on a heatpad, typically 95/75, once as low as 72/58. It goes high when I sit upright. I walk to reduce pain and BP also.
My first 3 visits to ED was on weekends, so no scans were done. The first in XXXXXXX 2014 they said they found nothing, and did not inform me of CKD found then for the first time and I discovered this myself later when I got the blood report. For the first 3 visits they seemed more concerned about ruling out a heart attack. In XXXXXXX 2015 the ED doctor said the pain might be the cyst, and as I knew my kidney function was low for the past year, he said a diuretic med may or may not cause impairment, but in any case said impairment was probably with kidneys. I read today that diuretics may help cause the formation of kidney stones. I wonder why I have kidney impairment CKD.... what is the cause?
But why were there no report of stones on recent scans:
When there was swelling from a bowel infection, a scan was done on July 27 this year. A CT abdomen scan with contrast, and they mention the parapelvic cysts, but no mention of stones. Would this not be seen, or not much looked for if the main issue then was the bowel?
And an MRI with and without contrast was done on Aug 19 as a follow up on the renal cyst. No mention of kidney stones.... but perhaps MRI is not useful for detecting kidney stones?
And as I have advised all the doctors of the pain and symptoms, yet none suggested kidney stones, I find this strange.
Can you advise further?
Above should read "but in any case said the impairment was probably with BOTH kidneys to have stage 3 CKD"
Dr. Saha
Your suggestion of kidney stones seems to fit my symptoms: I have constant pain that is level 3 or 4 out of 10, goes to 5, agony level, and at times 8 or 9 which sends me to ED, Emergency. I cannot sit up right, only a few minutes whereby pain and BP rises, and very difficult to drive a vehicle, and only by inclining the seat to about 45 degrees and still very painful. I sleep on my right side only for a long time, but this improved a little bit. I eat most of my meal standing. When I visit a doctor I remain standing.
At present my BP goes very low when I lie on a heatpad, typically 95/75, once as low as 72/58. It goes high when I sit upright. I walk to reduce pain and BP also.
My first 3 visits to ED was on weekends, so no scans were done. The first in XXXXXXX 2014 they said they found nothing, and did not inform me of CKD found then for the first time and I discovered this myself later when I got the blood report. For the first 3 visits they seemed more concerned about ruling out a heart attack. In XXXXXXX 2015 the ED doctor said the pain might be the cyst, and as I knew my kidney function was low for the past year, he said a diuretic med may or may not cause impairment, but in any case said impairment was probably with kidneys. I read today that diuretics may help cause the formation of kidney stones. I wonder why I have kidney impairment CKD.... what is the cause?
But why were there no report of stones on recent scans:
When there was swelling from a bowel infection, a scan was done on July 27 this year. A CT abdomen scan with contrast, and they mention the parapelvic cysts, but no mention of stones. Would this not be seen, or not much looked for if the main issue then was the bowel?
And an MRI with and without contrast was done on Aug 19 as a follow up on the renal cyst. No mention of kidney stones.... but perhaps MRI is not useful for detecting kidney stones?
And as I have advised all the doctors of the pain and symptoms, yet none suggested kidney stones, I find this strange.
Can you advise further?
Above should read "but in any case said the impairment was probably with BOTH kidneys to have stage 3 CKD"
Brief Answer:
Management of the CKD is of prime importance now
Detailed Answer:
Thanks for writing back.
Kidney stones, or for that matter any possible cause of obstruction, can cause backpressure on the renal system that includes the ureters and kidneys. While an attempt to move the stones downward could result in spasms, in absence of stones such spasms themselves could be the cause of obstruction. However, most often narrowing somewhere is due to anatomical cause and source of backpressure that could cause the formation of cyst or dilation and could result in CKD in long standing cases. Had a stone been present, it would have shown up on a radiological scan (ultrasonography) although not all stones are radio-opaque (on X-Ray). Diabetes is another possible cause of CKD.
MRIs are simply great in detecting problems involving soft tissues and are also effective in detecting stones if they are present.
Possibly since a stone would have been easily detected, but no such thing has occurred, the doctors have not mentioned anything about stones.
The problem with BP is called postural hypotension. It may be related to low blood volume which could be a sequele of your CKD since the kidneys produce erythropoetin (that mediates blood production) and the kidneys are compromised in your case.
Regards
Management of the CKD is of prime importance now
Detailed Answer:
Thanks for writing back.
Kidney stones, or for that matter any possible cause of obstruction, can cause backpressure on the renal system that includes the ureters and kidneys. While an attempt to move the stones downward could result in spasms, in absence of stones such spasms themselves could be the cause of obstruction. However, most often narrowing somewhere is due to anatomical cause and source of backpressure that could cause the formation of cyst or dilation and could result in CKD in long standing cases. Had a stone been present, it would have shown up on a radiological scan (ultrasonography) although not all stones are radio-opaque (on X-Ray). Diabetes is another possible cause of CKD.
MRIs are simply great in detecting problems involving soft tissues and are also effective in detecting stones if they are present.
Possibly since a stone would have been easily detected, but no such thing has occurred, the doctors have not mentioned anything about stones.
The problem with BP is called postural hypotension. It may be related to low blood volume which could be a sequele of your CKD since the kidneys produce erythropoetin (that mediates blood production) and the kidneys are compromised in your case.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply.
You say any type of obstruction could cause these spasms. I saw my family doctor yesterday and he was only aware of stones causing renal colic. But I have read a number of items that supports your view that any type of blockage can cause this. So, would inflamed or enlarged prostate cause it? And I read on some China kidney hospital sites that parapelvic cysts larger than 3 cm can cause pain and problems with pressure on the kidney and surrounding area. And on "Healthcaremagic" item on kidneys one recommendation is that all large parapelvic cysts be removed (in that case it was 7.5 cm, but no pain symptom). So your view that cyst size is not a problem for pain, while in agreement with the doctor here, seems not universal. Can you comment? And another comment I read is that the renal artery could be obstructed? Most I have read suggest renal colic have pain that radiates down to the groin area. I have most pain from upper left abdomen, left kidney area,flank, but a lot also up in my left shoulder blade area. I read that electrolyte disorders can also cause spasms. Could this be a problem, as kidneys regulate that.
I have issues with lethargy and muscle weakness and some reflex issues.
I will give a little history: Just over 5 years ago, in 2010 I had electric shock feeling in the chest, ED thought it was a heart attack, but it wasn't. Later said it was left bundle block. At admission I also an seizure of the whole body for about 10 minutes, and could not talk for a 5 minutes or so . They said PTSD symptoms. Then 6 months later I was admitted for gallbladder infection, and on IV, no food for a week. I lost about 80 percent of my hearing, but this came back gradually. No explanation for that, but my potassium was low,on that and another occasion. Looking back I wonder if that was due to the diuretic BP med that can reduce potassium? But the hospital also said the gallbladder infection may have been secondary to a bowel infection. They could find no gallstones. Three months later my liver could went high. They could find no cause and returned to normal after a few days in hospital. After this scan showed my gallbladder always contracted, even afer fasting. So it wasn't working. for the next four years.
My blood test since 2010 has showed irregularity as to white blood counts. And my ferritin gradually climbed up to about 550. My electric shock feelings would re-occur every 4 or 5 months and take about a month to disappear.
When these spasms in abdomen and flank started, in 2013; at this time I had increased Lorezepam from .25 mg to 3 mg. Also when the kidney cyst was 3.5 cm I had no pain or spasms. Spasms started 2 or 3 month after the cyst was 4.8 cm.
In XXXXXXX 2014 the CKD and bowel problem popped up.
Anyway, as I was having considerably more muscle tightness and poor sleep, I felt likely it was withdrawal form the Lorezepam, and about March 2014 I tapered off, now more that a year ago. It seems to help but didn't solve the pain and spasm problem. Yet in XXXXXXX this year I did ok on a cardiac stress test. I have about 50 percent blockage in 3 arteries, found in 2010, but seems no worse after 5 years. No bundle block. No electric shock feeling since more that a year, since going off Lorezapam. I had been on low dose for 20 years, then higher dose for just a couple of months. I understand in some countries this is never used beyond 4 weeks, but I was never aware of this.) I read last year that this drug can cause electric shock feelings, seizures and muscle tension and many other problems, so I decided to not use it anymore. And most interesting, My recent CT scan seems to say the gallbladder is now working!. In 2011, when the liver count when high I asked the doctor if muscle tension could cause that. He said it was possible but difficult to prove.
Most doctors here suggest I have muscular issues with this pain and spasm, and I have had anxiety and muscle tension issues, but the CKD, the cyst and bowel issues seem to overlap. Not sure if this information helps your assessment. I agree that management of the CKD is very important, and I am trying stretch exercise, and seem to help a little with the muscle tension. But no doctor says what is the cause of the pain and spasms. Look forward to your further reply.
You say any type of obstruction could cause these spasms. I saw my family doctor yesterday and he was only aware of stones causing renal colic. But I have read a number of items that supports your view that any type of blockage can cause this. So, would inflamed or enlarged prostate cause it? And I read on some China kidney hospital sites that parapelvic cysts larger than 3 cm can cause pain and problems with pressure on the kidney and surrounding area. And on "Healthcaremagic" item on kidneys one recommendation is that all large parapelvic cysts be removed (in that case it was 7.5 cm, but no pain symptom). So your view that cyst size is not a problem for pain, while in agreement with the doctor here, seems not universal. Can you comment? And another comment I read is that the renal artery could be obstructed? Most I have read suggest renal colic have pain that radiates down to the groin area. I have most pain from upper left abdomen, left kidney area,flank, but a lot also up in my left shoulder blade area. I read that electrolyte disorders can also cause spasms. Could this be a problem, as kidneys regulate that.
I have issues with lethargy and muscle weakness and some reflex issues.
I will give a little history: Just over 5 years ago, in 2010 I had electric shock feeling in the chest, ED thought it was a heart attack, but it wasn't. Later said it was left bundle block. At admission I also an seizure of the whole body for about 10 minutes, and could not talk for a 5 minutes or so . They said PTSD symptoms. Then 6 months later I was admitted for gallbladder infection, and on IV, no food for a week. I lost about 80 percent of my hearing, but this came back gradually. No explanation for that, but my potassium was low,on that and another occasion. Looking back I wonder if that was due to the diuretic BP med that can reduce potassium? But the hospital also said the gallbladder infection may have been secondary to a bowel infection. They could find no gallstones. Three months later my liver could went high. They could find no cause and returned to normal after a few days in hospital. After this scan showed my gallbladder always contracted, even afer fasting. So it wasn't working. for the next four years.
My blood test since 2010 has showed irregularity as to white blood counts. And my ferritin gradually climbed up to about 550. My electric shock feelings would re-occur every 4 or 5 months and take about a month to disappear.
When these spasms in abdomen and flank started, in 2013; at this time I had increased Lorezepam from .25 mg to 3 mg. Also when the kidney cyst was 3.5 cm I had no pain or spasms. Spasms started 2 or 3 month after the cyst was 4.8 cm.
In XXXXXXX 2014 the CKD and bowel problem popped up.
Anyway, as I was having considerably more muscle tightness and poor sleep, I felt likely it was withdrawal form the Lorezepam, and about March 2014 I tapered off, now more that a year ago. It seems to help but didn't solve the pain and spasm problem. Yet in XXXXXXX this year I did ok on a cardiac stress test. I have about 50 percent blockage in 3 arteries, found in 2010, but seems no worse after 5 years. No bundle block. No electric shock feeling since more that a year, since going off Lorezapam. I had been on low dose for 20 years, then higher dose for just a couple of months. I understand in some countries this is never used beyond 4 weeks, but I was never aware of this.) I read last year that this drug can cause electric shock feelings, seizures and muscle tension and many other problems, so I decided to not use it anymore. And most interesting, My recent CT scan seems to say the gallbladder is now working!. In 2011, when the liver count when high I asked the doctor if muscle tension could cause that. He said it was possible but difficult to prove.
Most doctors here suggest I have muscular issues with this pain and spasm, and I have had anxiety and muscle tension issues, but the CKD, the cyst and bowel issues seem to overlap. Not sure if this information helps your assessment. I agree that management of the CKD is very important, and I am trying stretch exercise, and seem to help a little with the muscle tension. But no doctor says what is the cause of the pain and spasms. Look forward to your further reply.
Brief Answer:
You seem to have a large number of problems
Detailed Answer:
Thanks for writing back.
Usually spasms occur in an attempt to squeeze stones down. However, spasms can also occur in absence of any kidney stone or ureteric stone. On the other hand, obstruction due to any cause can lead to dilatation of the parts of the renal tract that precede the block. Prostatic enlargement can indeed cause blockage which may cause backpressure and thereby cause such dilatation. Parapelvic cysts can also be associated. Renal artery obstruction is likely to be independent to blockage, obstruction or cyst. However, renal artery obstruction can lead to infact killing of the area and subsequently leading to formation of an empty cyst in the parapelvic region.
Electrolyte imbalance can cause spasms but that is independent of any obstruction or renal pathology.
Your muscle issues seem independent.
Diuretic medicines often cause reduction in sodium levels but potassium levels usually remains unaffected. However, electrolyte imbalances are more likely to be caused due to your CKD.
Regards
You seem to have a large number of problems
Detailed Answer:
Thanks for writing back.
Usually spasms occur in an attempt to squeeze stones down. However, spasms can also occur in absence of any kidney stone or ureteric stone. On the other hand, obstruction due to any cause can lead to dilatation of the parts of the renal tract that precede the block. Prostatic enlargement can indeed cause blockage which may cause backpressure and thereby cause such dilatation. Parapelvic cysts can also be associated. Renal artery obstruction is likely to be independent to blockage, obstruction or cyst. However, renal artery obstruction can lead to infact killing of the area and subsequently leading to formation of an empty cyst in the parapelvic region.
Electrolyte imbalance can cause spasms but that is independent of any obstruction or renal pathology.
Your muscle issues seem independent.
Diuretic medicines often cause reduction in sodium levels but potassium levels usually remains unaffected. However, electrolyte imbalances are more likely to be caused due to your CKD.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again for your reply.
While I feel I have not had obstruction in the sense of difficult urinating, nevertheless, following bowel infection 4 months ago I monitored my daily volume and found I was at only 0.75 liters per 24 hours. So I started drinking more liquid and gradually got it up to 2 litres per day. So I may have been dehydrated.
I have been given no reason for the cause of CKD, and now that I have taken steps to reverse the kidney impairment, a doctor (a nephraologist) suggested the extra fluid flushed out the kidneys. This is a simple explanation: too little fluid intake causes CKD, and more fluid repaired it! Yet I know fluid is important. But the impairment lasted 1.5 years, and my drinking pattern never changed as far as I know.
But as to the pain and spasms, you feel that both enlarged /inflamed prostate and this cyst can trigger spasms. And possibly CKD? Maybe not CKD?
Yesterday I got some blood test results. Some good news is that my high ferritin levels is improving. This got higher over the past 5 years and at about 550, with the upper acceptable range of 300. Now it is down to 469. I have had no explanation why this went high. Does kidney performance affect that? High ferritin usually suggest high red blood cells I believe, except in cases of chronic infection where one can have anemia. And my blood test have suggested anemia, if I understand it correctly.
The bad news is that I have a positive ANA test:at a titre of 1:320, with homogenous pattern. This suggests an autoimmune disorder: maybe this is the source of the pain? I read that one of the signs is inflammation and damage to organs and tissues ... including kidneys. So could this be a possible cause of CKD instead of just dehydrated?
Another thing as to kidneys, that cyst pressure or spasm pressure may increase production of renin hormone that can spike blood pressure? I have issues with blood pressure spiking,(to emergency level) likely anxiety related also. A doctor suggested 2 years ago that I get the hormones tested, but has never been done, as it seems only specialtists can order this , not general family doctors. Do you think this needs follow up?
For clarification, I had been on a blood pressure med for 20 years: Indapamide, which is not a potassium sparing diuretic ( which may explain low potassium in 2010 and 2011 ). I have read that once one has some partial blockage in the heart arteries, this med should not be used). So I stopped using this last year.
You reply have been helpful, especially on the CKD issue. I am of the opinion that kidneys are perhaps second to the brain as to complexity and variety of function. I am also of the opinion that my doctors here are not very concerned, and that if EGFR is at 60, then don't worry. But 60, as I understand, still means about 50 percent loss of function, and you say they are compromised.
As my original question was about kidneys, CKD and cysts, I am getting better insight from you on this, and would appreciate anything else you can add or clarify. Or what type of specialtists I should consult to get help with this pain problem?
Regards XXXXXXX
While I feel I have not had obstruction in the sense of difficult urinating, nevertheless, following bowel infection 4 months ago I monitored my daily volume and found I was at only 0.75 liters per 24 hours. So I started drinking more liquid and gradually got it up to 2 litres per day. So I may have been dehydrated.
I have been given no reason for the cause of CKD, and now that I have taken steps to reverse the kidney impairment, a doctor (a nephraologist) suggested the extra fluid flushed out the kidneys. This is a simple explanation: too little fluid intake causes CKD, and more fluid repaired it! Yet I know fluid is important. But the impairment lasted 1.5 years, and my drinking pattern never changed as far as I know.
But as to the pain and spasms, you feel that both enlarged /inflamed prostate and this cyst can trigger spasms. And possibly CKD? Maybe not CKD?
Yesterday I got some blood test results. Some good news is that my high ferritin levels is improving. This got higher over the past 5 years and at about 550, with the upper acceptable range of 300. Now it is down to 469. I have had no explanation why this went high. Does kidney performance affect that? High ferritin usually suggest high red blood cells I believe, except in cases of chronic infection where one can have anemia. And my blood test have suggested anemia, if I understand it correctly.
The bad news is that I have a positive ANA test:at a titre of 1:320, with homogenous pattern. This suggests an autoimmune disorder: maybe this is the source of the pain? I read that one of the signs is inflammation and damage to organs and tissues ... including kidneys. So could this be a possible cause of CKD instead of just dehydrated?
Another thing as to kidneys, that cyst pressure or spasm pressure may increase production of renin hormone that can spike blood pressure? I have issues with blood pressure spiking,(to emergency level) likely anxiety related also. A doctor suggested 2 years ago that I get the hormones tested, but has never been done, as it seems only specialtists can order this , not general family doctors. Do you think this needs follow up?
For clarification, I had been on a blood pressure med for 20 years: Indapamide, which is not a potassium sparing diuretic ( which may explain low potassium in 2010 and 2011 ). I have read that once one has some partial blockage in the heart arteries, this med should not be used). So I stopped using this last year.
You reply have been helpful, especially on the CKD issue. I am of the opinion that kidneys are perhaps second to the brain as to complexity and variety of function. I am also of the opinion that my doctors here are not very concerned, and that if EGFR is at 60, then don't worry. But 60, as I understand, still means about 50 percent loss of function, and you say they are compromised.
As my original question was about kidneys, CKD and cysts, I am getting better insight from you on this, and would appreciate anything else you can add or clarify. Or what type of specialtists I should consult to get help with this pain problem?
Regards XXXXXXX
Brief Answer:
A nephrologist will be able to guide you better.
Detailed Answer:
Sitting at a distance with limited contextual resources (like ability to examine and simultaneously correlate with all the reports) limits my capacity to explain all your queries to you. Moreover, scrolling long queries increases the possibilities of leaving out things. So, I would appreciate if you could keep your queries short and precise.
Your nephrologist would be able to specify the exact amount of fluid intake allowable. You should not deviate from it as the capacity of your kidneys is limited. Increasing the fluid intake will not revitalize your kidneys. A dead man does not start walking if the cause of death is reversed or a person with lungs already damaged due to smoking does not get back lungs in proper health after he quits smoking. The damage that has been done, has been done and there is no way to reverse it. You have CKD and will have to live with it. The cyst is likely to be a sequele of the cause of your CKD; the cyst is unlikely to be the cause. Your hormones may need a follow up. Discuss with your treating physician (who would ultimately be interpreting the reports) whether he thinks them to be necessary in the present context of treatment.
Nothing more to say. Be in follow up with your nephrologist.
About the pain, antispasmodics might help. But those are prescription medications and you would need your doctor to write them down for you.
Regards
A nephrologist will be able to guide you better.
Detailed Answer:
Sitting at a distance with limited contextual resources (like ability to examine and simultaneously correlate with all the reports) limits my capacity to explain all your queries to you. Moreover, scrolling long queries increases the possibilities of leaving out things. So, I would appreciate if you could keep your queries short and precise.
Your nephrologist would be able to specify the exact amount of fluid intake allowable. You should not deviate from it as the capacity of your kidneys is limited. Increasing the fluid intake will not revitalize your kidneys. A dead man does not start walking if the cause of death is reversed or a person with lungs already damaged due to smoking does not get back lungs in proper health after he quits smoking. The damage that has been done, has been done and there is no way to reverse it. You have CKD and will have to live with it. The cyst is likely to be a sequele of the cause of your CKD; the cyst is unlikely to be the cause. Your hormones may need a follow up. Discuss with your treating physician (who would ultimately be interpreting the reports) whether he thinks them to be necessary in the present context of treatment.
Nothing more to say. Be in follow up with your nephrologist.
About the pain, antispasmodics might help. But those are prescription medications and you would need your doctor to write them down for you.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes, my queries have been long, as I have given other information in hope that something might grab your attention, as to the cause of my pain that I and doctors here have missed.
Basically you indicate that EGFR less than 60 is a matter that should be taken serious. And you say a nephrologist should be able to specify the amount of allowable fluid intake. I had been of the opinion that lots of fluid was always good, but now read elsewhere that too much is not good when the kidney is impaired, so what you say seems correct. But the nephrologist here made no recommendation on fluid intake, diet or anything else, nor did the urologist or family doctors.
I get your point that kidney damage is permanent, but is it so absolute as you suggest? I have reversed my creatinine and urea and EGFR. The EGFR had averaged about 55, with a range of 52 to 57, but now is 60 or better. Perhaps the range variation is due to the test accuracy, and we seem to have no way to know what the EGFR number is once it is 60 or more, whether it is significant or not. And Chinese kidney hospital sites claim that their treatment, micro-Chinese medicine osmotherapy can both shrink cysts and also repair the damaged kidneys as well as improve kidney function (which function I am not sure). They say that reduction of the cyst size improves blood circulation and kidney function will be improved. On my own, with heat on the kidneys, lower blood pressure, diet improvements, and exercise, and perhaps appropriate level of fluid, and elimination of some medication, whether some or all of this have helped improve the function, or so it seems. Please give your thoughts.
As to whether the cyst can cause CKD, again the Chinese site says "compression of a large cyst (4cm or more) to the renal tissues can cause renal ischemia and elevate blood pressure" I was aware that high blood pressure can be a risk for heart attack or stroke, but am only now aware it can damage the kidneys, and as well, damage kidneys in turn can elevate the blood pressure. As I have not been told why I got CKD, it seems likely it is blood pressure related, do you agree?
Again, as for the pain, it is uncertain as the cause: renal colic, with the cyst a factor, bowel infection, medication induced(withdrawal effects from Lorezepam) or arthritis or other autoimmune disease. Do you think it wise I consult an internist? I am considering a visit to a USA mayo Clinic, where one sees an internist or a specialist. I am located in Newfoundland Canada, and this would be expensive, and the trip troublesome as I have pain when sitting. I have wondered where you are located, and do you teach medicine also? Oh, and my urine volume for the past week has varied from 1.2 to 2.4 litres. I tried both Advil and then Celebrex for some pain relief, but little benefit. But I notice a big reduction in volume following the medication and increase after discontinue of the medication. I took Celebrex long term and wonder it this could have caused CKD? And I have seen Advil both recommended for and against use for kidney impairment.
Again, too long are my queries, sorry, but I look forward to your thoughts.
Basically you indicate that EGFR less than 60 is a matter that should be taken serious. And you say a nephrologist should be able to specify the amount of allowable fluid intake. I had been of the opinion that lots of fluid was always good, but now read elsewhere that too much is not good when the kidney is impaired, so what you say seems correct. But the nephrologist here made no recommendation on fluid intake, diet or anything else, nor did the urologist or family doctors.
I get your point that kidney damage is permanent, but is it so absolute as you suggest? I have reversed my creatinine and urea and EGFR. The EGFR had averaged about 55, with a range of 52 to 57, but now is 60 or better. Perhaps the range variation is due to the test accuracy, and we seem to have no way to know what the EGFR number is once it is 60 or more, whether it is significant or not. And Chinese kidney hospital sites claim that their treatment, micro-Chinese medicine osmotherapy can both shrink cysts and also repair the damaged kidneys as well as improve kidney function (which function I am not sure). They say that reduction of the cyst size improves blood circulation and kidney function will be improved. On my own, with heat on the kidneys, lower blood pressure, diet improvements, and exercise, and perhaps appropriate level of fluid, and elimination of some medication, whether some or all of this have helped improve the function, or so it seems. Please give your thoughts.
As to whether the cyst can cause CKD, again the Chinese site says "compression of a large cyst (4cm or more) to the renal tissues can cause renal ischemia and elevate blood pressure" I was aware that high blood pressure can be a risk for heart attack or stroke, but am only now aware it can damage the kidneys, and as well, damage kidneys in turn can elevate the blood pressure. As I have not been told why I got CKD, it seems likely it is blood pressure related, do you agree?
Again, as for the pain, it is uncertain as the cause: renal colic, with the cyst a factor, bowel infection, medication induced(withdrawal effects from Lorezepam) or arthritis or other autoimmune disease. Do you think it wise I consult an internist? I am considering a visit to a USA mayo Clinic, where one sees an internist or a specialist. I am located in Newfoundland Canada, and this would be expensive, and the trip troublesome as I have pain when sitting. I have wondered where you are located, and do you teach medicine also? Oh, and my urine volume for the past week has varied from 1.2 to 2.4 litres. I tried both Advil and then Celebrex for some pain relief, but little benefit. But I notice a big reduction in volume following the medication and increase after discontinue of the medication. I took Celebrex long term and wonder it this could have caused CKD? And I have seen Advil both recommended for and against use for kidney impairment.
Again, too long are my queries, sorry, but I look forward to your thoughts.
Brief Answer:
Your CKD is likely to be a sequel of your high blood pressure.
Detailed Answer:
Thanks for writing back.
An eGFR of 60 indicates stage 2 (below 59 is stage 3) CKD and so should be taken seriously. Such range of variation between 50 and 60 is absolutely normal. It is similar to your pulse rate or BP- never remains the same.
High blood pressure has damaging action on a number of organs including the kidneys. If you have had high blood pressure, there is significant possibility that your CKD is actually a sequel of it. Long term use of pain medication also have damaging effect on the kidneys and could have had a contributory role alongside.
As for the pain, it is unlikely to be due to withdrawal of lorazepam. It could have a autoimmune background but for all practical purpose, its renal colic.
Irrespective of where you visit for medical facilities, your condition is irreversible and you need to live with it. In future, dialysis is likely to be required, unless you are already on it. I would not suggest a long journey hoping for better treatment as the treatment of your condition is standard and should be the same at any standard center for medical care.
I would insist you to discuss about the choice of pain medication with your nephrologist. Hard to comment from my side.
Your long query this time makes sense as you had properly summarized and had a number of things to ask. It gets confusing when there is good amount of information and we need to sort through to find what is relevant. While answering from a XXXXXXX device scrolling becomes cumbersome.
Feel free to ask back anytime.
Regards
Your CKD is likely to be a sequel of your high blood pressure.
Detailed Answer:
Thanks for writing back.
An eGFR of 60 indicates stage 2 (below 59 is stage 3) CKD and so should be taken seriously. Such range of variation between 50 and 60 is absolutely normal. It is similar to your pulse rate or BP- never remains the same.
High blood pressure has damaging action on a number of organs including the kidneys. If you have had high blood pressure, there is significant possibility that your CKD is actually a sequel of it. Long term use of pain medication also have damaging effect on the kidneys and could have had a contributory role alongside.
As for the pain, it is unlikely to be due to withdrawal of lorazepam. It could have a autoimmune background but for all practical purpose, its renal colic.
Irrespective of where you visit for medical facilities, your condition is irreversible and you need to live with it. In future, dialysis is likely to be required, unless you are already on it. I would not suggest a long journey hoping for better treatment as the treatment of your condition is standard and should be the same at any standard center for medical care.
I would insist you to discuss about the choice of pain medication with your nephrologist. Hard to comment from my side.
Your long query this time makes sense as you had properly summarized and had a number of things to ask. It gets confusing when there is good amount of information and we need to sort through to find what is relevant. While answering from a XXXXXXX device scrolling becomes cumbersome.
Feel free to ask back anytime.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Time running out for me to respond , just a few minutes, I was looking through my records on kidney function, to see if recent performance is significant in your opinion, I will follow up and give you the numbers if that is ok, please advise
Regards XXXXXXX
Regards XXXXXXX
Brief Answer:
No issues
Detailed Answer:
No issues at all. But you have already mentioned figures that are conclusive enough.
No issues
Detailed Answer:
No issues at all. But you have already mentioned figures that are conclusive enough.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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