Managing Chronic Kidney Issues and Associated Symptoms: A Guide

Physical weakness

Hello doctor, since last week I've been experiencing a dull pain on the right side of my lower back.
Due to my history of kidney disease, I've been particularly attentive to my urination, and there haven't been any abnormalities.
However, in the past few days, the pain has shifted to the left side.
I often have kidney issues during this time of year, as my initial diagnosis was pyelonephritis, followed by kidney stones.
Since then, I've had flare-ups almost every year around this time.
Initially, it starts with back pain, but my urination usually remains normal until I suddenly develop a high fever, which indicates a flare-up.
Sometimes, if I seek medical attention early, medication is sufficient, but when the fever occurs, hospitalization is necessary.
During regular check-ups, my urine tests often show elevated white blood cell counts, even when I have no symptoms.
What should I do about this? Additionally, I've recently started experiencing occasional heart pain and an overwhelming need for sleep, often requiring more than twelve hours a day; otherwise, I struggle to wake up.
Sometimes, when I do wake up, I have severe pain in the lower right side of my head, which can last for a day or sometimes resolve in half a day.
My health has deteriorated to the point where it significantly affects my work.
If I need to go to the hospital for an examination, which department should I see? What tests should I undergo?

Xuejing, 20~29 year old female. Ask Date: 2008/06/20

Dr. Wang Weijie reply Internal Medicine

Dear Xueqing,
Hello.
The symptoms of acute pyelonephritis include fever, flank pain, frequent urination, and a burning sensation during urination, and these symptoms may vary from person to person.
An ultrasound has revealed the presence of kidney stones; what is the size of the stones? Has the physician provided any recommendations? Generally, kidney stones do not require special treatment unless they are causing recurrent acute pyelonephritis, in which case referral to a urologist is necessary.
Options such as extracorporeal shock wave lithotripsy may be available, but it will depend on the individual’s condition.
To prevent acute pyelonephritis, it is advisable to drink plenty of water and cranberry juice, avoid holding in urine, maintain good hygiene practices, and if engaging in sexual activity, urinate before and after.
Wearing breathable cotton underwear can also reduce the risk of occurrence.
For severe headaches, I recommend consulting a neurologist to check for any issues related to migraines.
Wishing you safety and health.
Sincerely,
Dr.
Wang Weijie
Director of Nephrology, Taoyuan Hospital, Department of Health

Reply Date: 2008/06/20

More Info

Managing chronic kidney issues can be a complex process, especially when accompanied by symptoms such as flank pain, urinary changes, and systemic symptoms like fatigue and heart discomfort. Based on your history of kidney disease, including pyelonephritis and kidney stones, it is crucial to approach your current symptoms with a comprehensive strategy.

Understanding Your Symptoms
1. Flank Pain: The pain you are experiencing on the right and left sides of your lower back could be related to your kidneys. In patients with a history of kidney stones or infections, flank pain can indicate a recurrence of these issues. It is essential to monitor any changes in your urinary habits, such as increased frequency, urgency, or changes in the color or odor of your urine.

2. Urinary Symptoms: You mentioned that your urine has not shown significant changes, but the presence of elevated white blood cells in your urine during routine checks is concerning. This could indicate an ongoing infection or inflammation in the urinary tract, even if you are not experiencing acute symptoms.

3. Systemic Symptoms: The fatigue you are experiencing, along with the need for excessive sleep and episodes of severe headaches, could be related to several factors, including kidney function decline, electrolyte imbalances, or even cardiovascular issues. The heart pain you mentioned should not be ignored, as it could signify a more serious condition.

Recommended Actions
1. Consultation: Given your symptoms and medical history, it is advisable to consult a nephrologist (kidney specialist) for your kidney-related concerns. Additionally, if you are experiencing heart pain, a visit to a cardiologist may also be warranted.
2. Diagnostic Tests: The following tests may be recommended:
- Urinalysis: To check for signs of infection, blood, or protein in the urine.

- Blood Tests: Including serum creatinine and blood urea nitrogen (BUN) to assess kidney function, as well as electrolytes to check for imbalances.

- Imaging Studies: An ultrasound or CT scan of the kidneys may be necessary to evaluate for stones, obstructions, or other structural abnormalities.

- Echocardiogram or EKG: If you are experiencing heart pain, these tests can help assess heart function and rule out any cardiac issues.

3. Monitoring and Management:
- Hydration: Ensure you are adequately hydrated, as dehydration can exacerbate kidney issues and lead to stone formation.

- Dietary Adjustments: Depending on your kidney function, a low-sodium and low-protein diet may be beneficial. Consult with a dietitian specializing in renal nutrition for personalized advice.

- Regular Follow-ups: Regular check-ups with your healthcare provider are essential to monitor your kidney function and adjust your management plan as needed.

4. Symptom Management: For your fatigue and headaches, it may be helpful to keep a symptom diary to identify any potential triggers or patterns. Discuss these symptoms with your healthcare provider, as they may suggest lifestyle modifications or medications to help manage them.

Conclusion
Your symptoms warrant a thorough evaluation to determine the underlying causes and appropriate management strategies. It is crucial to address both your kidney health and any cardiovascular concerns. Early intervention can prevent complications and improve your quality of life. Make sure to communicate openly with your healthcare providers about all your symptoms and concerns, as this will aid in developing a comprehensive care plan tailored to your needs.

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