Kidney pain
Kidney pain most often occurs with inflammatory lesions — pyelonephritis, glomerulonephritis. Pain syndrome occurs in nephroptosis, urolithiasis, emergency conditions (kidney infarction, renal vein thrombosis). Instrumental methods are used for diagnosis: ultrasound, urography, CT. Laboratory tests of urine and blood are used. To clarify the diagnosis, a kidney biopsy is performed. Conservative treatment includes antibiotics, corticosteroids, diuretics and hypotensive agents. According to the indications, hemodialysis or peritoneal dialysis, surgical intervention is prescribed.
Causes of kidney pain
Pyelonephritis
Glomerulonephritis
Urolithiasis
Hydronephrosis
Nephroptosis
Kidney infarction
Renal vein thrombosis
Neoplasms
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of kidney pain
Pyelonephritis
In an acute process, lower back pain begins suddenly, against the background of complete health. Unpleasant sensations spread along the ureter, less often they radiate into the area of the anterior abdominal wall. The symptom usually appears after hypothermia, with inflammation of the urethra and bladder. The clinical picture is complemented by febrile fever, chills, malaise. Occasionally, dyspeptic disorders bother.
With a recurrent variant of chronic pyelonephritis, mild aching pains in the lumbar region are observed. The symptom is accompanied by abdominal discomfort, soreness during urination, periodic fever. Such clinical signs persist for several months. A combination of kidney pain and high blood pressure is characteristic.
Glomerulonephritis
Acute glomerulonephritis is manifested by moderate pain in the lower back, which is caused by stretching of the kidney capsule. For the disease, the appearance of soreness is typical 2-3 weeks after a streptococcal or viral infection. In addition to the pain syndrome, morning edema occurs, which are noticeable after sleep and are mainly located on the face. The daily diuresis often decreases, the pink color of urine is less often determined.
In the chronic form of glomerulonephritis, the patient occasionally experiences non-intense pain in the kidney area. Signs of arterial hypertension with significant daily fluctuations in pressure indicators come to the fore. As with the acute form, there are constant edema, most pronounced in the morning. Shortness of breath and other symptoms of heart failure are bothering.
Urolithiasis
ICD with small stones is asymptomatic for a long time. Occasionally there is a non-intense pain on the side of the affected kidney. A typical clinic of renal colic appears when the ureter is blocked by a stone. An intense pain syndrome develops, which does not depend on a change in body position. Patients behave restlessly, trying to find a position in which the soreness will decrease. Later, hematuria joins.
Hydronephrosis
Acute hydronephrosis is manifested by sharp paroxysmal pains in the projection of the affected kidney. They spread along the ureter, radiate into the thigh, into the perineum. This disease is characterized by frequent and painful urge to urinate, nausea, vomiting. With infected hydronephrosis, the pain syndrome increases, combined with an increase in temperature to febrile values.
Nephroptosis
With moderate lowering of the kidneys, a pulling unilateral pain is felt in the lower back, discomfort and heaviness in the abdominal cavity are also typical. Discomfort increases with bends, physical exertion, disappears in a horizontal position. With severe nephroptosis, the pain becomes permanent, does not depend on the posture. With a complicated course of the disease, an attack of pain begins, similar to renal colic.
Kidney infarction
The intensity of pain is affected by the scale of organ damage. With a massive heart attack, severe pains suddenly develop, which are similar in intensity to renal colic. They are localized on one side. Because of the excruciating pain, patients are restless, rushing around the room, unable to find a comfortable position. The pain syndrome is accompanied by hematuria, which is manifested by the excretion of pink or red urine.
Renal vein thrombosis
Pathology belongs to the category of urgent conditions. Thrombosis is characterized by acute pain in the projection of the kidneys, the lateral parts of the abdomen. In addition to the pain syndrome, the patient feels a sharp deterioration in his condition, signs of intoxication are increasing — nausea and vomiting, weakness, drowsiness. Often there are systemic signs of the disease: pain in the lower extremities, their swelling and pasty.
Neoplasms
Benign cysts do not manifest themselves for a long time. Pain in the kidney develops when the neoplasm increases in size, squeezing the surrounding tissues and nerve endings. Pain is given to the groin, hip. With suppuration of large formations, chills and fever are noted, the pain increases. Severe soreness provoked by physical exertion indicates the threat of cyst rupture.
In kidney cancer, pain syndrome is a sign of a neglected process. The pains are unilateral, have a dull, aching nature. They are caused by stretching of the organ capsule, invasive tumor growth. There are no pain sensations at the initial stages. With malignant neoplasms of the kidney, a regular sequence of symptoms is observed: first, blood is detected in the urine, and then soreness occurs in the lumbar region.
Rare reasons
Renal insufficiency: acute and chronic.
Interstitial nephritis.
Purulent processes: apostematous nephritis, kidney carbuncle, pionephrosis.
Congenital anomalies: horseshoe kidney, aplasia or dysplasia of the kidney, polycystic.
Nephropathy: toxic, gouty, paraneoplastic.
Hepatorenal syndrome.
Diagnostics
When collecting anamnesis, the nephrologist takes into account the prescription of symptoms and events that preceded the manifestation of the disease. During physical examination, Pasternatsky’s symptom is checked, edema is searched. The data of laboratory and instrumental studies are crucial for identifying the causes of kidney pain. Diagnostics includes the following methods:
Urine tests. In kidney pathology, several specific changes are observed: the presence of protein, cellular elements (erythrocytes, leukocytes), cylinders. To assess the concentration function, a urine test is performed according to Zimnitsky, to confirm hematuria or leukocyturia, a Nechiporenko study is performed.
Blood tests. Leukocytosis and increased ESR in the hemogram indicate the inflammatory nature of the disease. In the biochemical study of blood, attention is paid to the level of total protein, albumins, and lipid profile. Creatinine and urea are evaluated.
Ultrasound of the kidneys. During sonography, the dimensions, contours and thickness of the kidney parenchyma are studied. According to ultrasound data, the expansion of the cup-pelvic system is established, concretions are detected in the kidneys or urinary tract. Renal blood flow is assessed by Dopplerography.
Excretory urography. The technique provides a detailed visualization of the structure of the kidneys and urinary tract. According to the results of this method, changes in the size of the organ, its deformation are detected, and the excretory function of the kidneys is evaluated. Urography is supplemented with other X-ray studies — CT, scintigraphy.
Kidney biopsy. These invasive studies are required for the differential diagnosis of chronic glomerulonephritis, autoimmune kidney lesions, neoplasms. During cytological examination of biopsies, attention is paid to infiltration by leukocytes, the presence of immune complexes, atypical cells.
Treatment
Help before diagnosis
With symptoms of acute nephritis, renal colic, the patient is immediately referred for inpatient treatment. With mild and moderate course, outpatient therapy is possible. Before identifying the cause of the pain syndrome, therapeutic measures include the organization of a gentle regime, the selection of dietary nutrition with a restriction of table salt. To alleviate the human condition, symptomatic therapy is carried out.
Conservative therapy
The patient’s management plan is determined by the clinical form of the disease and the etiological factor. For all types of pathology, strict accounting of the amount of fluid consumed and the volume of diuresis is shown in order to monitor the excretory and concentration function of the kidneys. In some nephrological diseases, it is necessary to limit protein intake. Drug therapy includes a number of drugs:
Diuretics. They allow to normalize diuresis, reduce swelling. Loop, thiazide and potassium-sparing diuretics are used depending on the electrolyte composition of the blood. Diuretics are recommended only for normal urinary tract patency.
Corticosteroids. The drugs quickly stop inflammation and have an immunosuppressive effect. They affect the cause of the disease, so kidney pain disappears quite quickly. Hormones are mainly used for glomerulonephritis, interstitial nephritis.
Antibiotic therapy. Etiotropic antibacterial drugs are administered for pyelonephritis and other infectious kidney injuries. Antibiotics from the group of cephalosporins and fluoroquinolones are mainly prescribed. With mild forms of infection, uroseptics are effective.
Antihypertensive drugs. Chronic kidney diseases are accompanied by hypertension, for the treatment of which ACE inhibitors, angiotensin-II receptor blockers are selected. Calcium antagonists are also prescribed to normalize blood pressure.
Means for detoxification. Detoxification therapy is appropriate for acute processes that are provoked by toxic effects. Specific antidotes are administered, infusion therapy, extracorporeal detoxification techniques are carried out.
With a significant violation of kidney function, replacement therapy is necessary — hemodialysis or peritoneal dialysis. The criteria for starting treatment are abnormal creatinine levels and insufficient glomerular filtration rate, changes in the potassium content in the blood, the presence of life-threatening complications, kidney failure.
Surgical treatment
In clinical urology, surgical techniques are more often used for urolithiasis, if there is no independent excretion of concretions. For small stones, flexible retrograde nephrolithotripsy, contact lithotripsy is used, for large concretions — nephrolithotomy. With severe developmental abnormalities, total kidney damage, nephrectomy is performed. In terminal forms of renal insufficiency, kidney transplantation is indicated.
