Right Kidney Pain: Causes and Concerns for Patients - Internal Medicine

Dr. Wu Hongjie reply Internal Medicine

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Hello: There are many issues related to lower back pain that can be referenced in the attached document or addressed at a hospital.
Wishing you safety from bothersome back pain.
In the United States, back pain is the second most common reason for seeking medical attention in internal medicine.
Risk factors include smoking, older age, female gender, obesity, and occupations that require heavy lifting or prolonged periods of maintaining the same posture (either sitting or standing).
Additionally, psychological factors such as anxiety and depression can manifest as lower back pain.

A detailed history should include inquiries about the location, duration, onset, severity, aggravating and relieving factors of the pain, as well as any previous similar episodes.
If the patient has a history of tumors, severe nighttime pain, unexplained weight loss, is over 50 years old, has pain lasting more than a month, or has not improved with prior treatments, special causes of pain (such as tumors) should be considered.
If fever is also present, inflammatory or infectious causes of back pain should be evaluated.
The causes of back pain are complex and can include common conditions such as muscle strain, lumbar osteoarthritis, herniated discs, sciatica, ankylosing spondylitis, compression fractures, osteomyelitis, muscle strains, polymyositis, kidney stones, pyelonephritis, pancreatitis, cauda equina syndrome, and spinal compression syndrome, among others.

Examinations should assess whether changes in the spine and posture provoke pain, the range of motion in the lumbar joints, palpation of the entire spine, straight leg raise test, examination of nerve roots at the lumbar (L5) and sacral (S1) levels, and peripheral pulses in the feet.
Chronic back pain with limited lumbar joint mobility may suggest ankylosing spondylitis.
Palpation of the entire spine can help distinguish between kyphosis and scoliosis.
If the straight leg raise test reveals radiation pain extending below the knee, it typically indicates nerve root involvement; numbness or weakness often suggests a neurological cause of back pain.
Cauda equina syndrome often presents with urinary retention and saddle anesthesia, usually requiring surgical intervention.
Lumbar spinal stenosis often manifests as pseudoclaudication, meaning pain and numbness in the feet while standing, which improves with rest.
Kidney or urinary tract stones and pyelonephritis typically present unilaterally; the former often causes acute back pain and may present with hematuria, while the latter may be accompanied by fever, dysuria, and pain during urination.
Urinalysis, renal ultrasound, and urinary tract imaging can assist in diagnosis.
If patients exhibit certain warning signs, caution should be exercised to rule out serious underlying conditions causing back pain, such as recent trauma, unexplained fever or weight loss, immunocompromised status, cancer history, intravenous drug use, osteoporosis (especially in those using steroids), age over 70, localized neurological symptoms, or back pain lasting more than six weeks.
If conversion symptoms are suspected due to psychological factors, the pain may be more superficial and exaggerated, often accompanied by a history of anxiety and depression.
For back pain lasting over six weeks, consider obtaining X-rays of the lumbar spine in both anteroposterior and lateral views.
CT scans and MRIs have better sensitivity for diagnosing infections, tumors, disc abnormalities, and lumbar spinal stenosis, and should be considered when these conditions are suspected.

Non-pharmacological treatments such as stretching, muscle strengthening exercises, yoga, chiropractic care, acupuncture, and massage have some efficacy.
Rehabilitation techniques commonly used include transcutaneous electrical nerve stimulation (TENS), shortwave diathermy, ultrasound therapy, and interferential therapy, all of which have some therapeutic effects.

Medications may include acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, antidepressants, and anticonvulsants, selected based on the clinical diagnosis.
For kidney or urinary tract stones, urologists may utilize extracorporeal shock wave lithotripsy or ureteroscopy for stone removal.
Pyelonephritis should be treated with effective antibiotics based on bacterial sensitivity.
Patients with cauda equina syndrome, spinal compression syndrome, or those exhibiting severe and progressively worsening neurological symptoms, persistent sciatica, or loss of sensation or reflexes should be considered for surgical intervention.
(The author is a nephrologist at Taoyuan General Hospital.)

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Reply Date: 2017/03/07