Flank pain

Symptoms of upper UTIs include fever, nausea, vomiting, and often severe flank pain. 

A 28-year-old female presents to her primary care physician s office with complaints of painful urination and frequent need to urinate which began 2 days ago. She denies vomiting, fever, nausea, or flank pain. Upon questioning she does admit that she is sexually active with only one partner and uses spermicidal jelly. 

Nephrolithiasis/ urolithiasis/ crystalluria IDV Onset Any time after initiation of therapy, especially if 4- fluid intake Symptoms Flank pain and/or abdominal pain, dysuria, frequency pyuria, hematuria, crystallauria rarely, Tserum creatinine and acute renal failure 1. History of nephrolithiasis 2. Fhtients unable to maintain adequate fluid intake 3. High peak IDV concentration 4. tDuration of exposure Drink at least 1.5-2 L of non-caffeinated fluid per day Tfluid intake at first sign of darkened urine monitor urinalysis and serum creatinine every 3-6 months Increased hydration pain control may consider switching to alternative agent stent placement may be required... 

Flank pain Pain in the side of the trunk between the right or left upper abdomen and the back (costovertebral angle). 

Scrotal pain, inguinal pain, flank pain, urethral discharge... 

Upper UTI Flank pain, fever, nausea, vomiting malaise Physical examination... 

Monitoring for fibrotic complications should include periodic cardiac auscultation, chest x-ray, echocardiography, and abdominal magnetic resonance imaging. Patients should report symptoms of flank pain, dys-uria, chest pain, and shortness of breath. 

Symptoms in the outpatient setting include change in urinary habits, weight gain, or flank pain. Clinicians typically notice symptoms of ARF before they are detected by inpatients. 

Back, stomach, head, rib, flank pain abdominal cramps chills fever flu-like symptoms heavy head/tired head cold headache moniliasis 5.2 15.7... 

Symptoms of lower UTI are frequent and present themselves often as painful urination without fever. Symptoms of upper UTI are fever and often flank pain. However, the majority of elderly patients with UTI are asymptomatic. UTI must be considered if in a midstream urine more than 10 bacteria/ml and more than 10 leucocytes/ml are found. A urine culture (and in patients with high fever also two blood cultures) should be taken prior to start of therapy. 

Nephrolithiasis (flank pain with or without hematuria) occurs in 4% of patients. 

Monitor for signs and symptoms of nephrolithiasis (flank pain and hematuria), and notify the physician if sympfoms occur if nephrolifhiasis occurs, expecf fherapyfo be interrupted for 1-3 days... 

Assess the patient for signs and symptoms of hypercalcemia, including constipation, deep bone or flank pain, excessive thirst, hypotonicity of muscles, increased urine output, nausea and vomiting, and renal calculi... 

A 59-year-old woman presents to an urgent care clinic with a 4-day history of frequent and painful urination. She has had fevers, chills, and flank pain for the last 2 days. Her physician advised her to immediately come to the clinic for evaluation. In the clinic she is febrile (38.5°C [101.3°F]) but otherwise stable and states she is not experiencing any nausea or vomiting. Her urine dipstick test is positive for leukocyte esterase. Urinalysis and urine culture are also ordered. Her past medical history is significant for three urinary tract infections in the past year. Each of these episodes was uncomplicated, treated with trimethoprim-sulfamethoxazole, and promptly resolved. She also has osteoporosis for which she takes a daily calcium supplement. The decision is made to treat her with oral antibiotics for a complicated urinary tract infection with close follow-up. Given her history what would be a reasonable empiric antibiotic choice Depending on the antibiotic choice are there potential drug interactions she should be counseled on ... 

Between 24 and 72 hours, the kidneys become damaged, giving rise to flank pain and acute renal tubular necrosis. 

Some patients receiving indinavir exhibit nephrolithiasis/urolithiasis including flank pain that may be accompanied by hematuria. The frequency of nephrolithiasis is dependent on the period of treatment with indinavir. Other side effects associated with indinavir include insulin resistance, hyperglycemia, asymptomatic hyperbilirubinemia, HIV lipodystrophy syndrome and skin abnormalities. Indinavir should not be coadministered with drugs that affect the cytochrome P-450 system (CYP3A4). Antacids are not recommended within 2 h of its administration, specifically didano-sine containing an antacid buffer. 

This patient also illustrates the importance of a travel history in clinical medicine. Her intermittent fevers came with striking regularity on alternate days, a history that suggests malaria in an individual who has been in an area in which malaria is known to exist. Her flank pain was not due to a urinary tract infection, but was actually related to the splenic enlargement that is so characteristic of malaria. 

Miss WS is a 26-year old woman, previously fit and well, admitted with a 2-day history of shaking chills, accompanied by a high fever and pain in the joints and muscles including flank pain, which is made worse on movement. She also complains of nausea, loss of appetite and headache. On examination ... 

A 52-year-old woman with a history of hypertension for 15 years developed acute left flank pain, nausea, and vomiting. On a previous similar occasion 2 weeks before she had had a trace of proteinuria and microscopic hematuria. A contrast-enhanced CT scan of the abdomen had not shown stones, hydronephrosis, or morphological abnormalities. She had had no rash. Her urine contained cocaine. Creatine kinase and lactate dehydrogenase activities were raised and there... 

When 99% ethanol was instilled into renal cysts under ultrasound guidance in 25 cases, there were 12 complications after puncture, either related to the puncture itself or caused by the ethanol (17). They included flank pain. 

Several reports have suggested that patients using indinavir may also develop a syndrome consisting of back or flank pain, accompanied by crystalluria, renal function abnormalities, and evidence of tubulointerstitial nephritis on renal biopsy, but without obvious renal calculus formation (15-17). 

Since the basic problem in many such cases is probably crystalluria, it should be possible to treat it with rehydration, perhaps supplemented by brief interruption of therapy this has been the conclusion of a study in which the unwanted renal effects of indinavir were prominent (25). Of 74 individuals infected with HIV-1 and taking indinavir 2.4 g/day orally, 15 had indinavir-related urological adverse effects (19 episodes), most commonly dull flank pain and dysuria. Microhematuria occurred in 16 of the 19 episodes. Four patients had urinary tract distension on... 

The acute flank pain syndrome associated with reversible renal insufficiency is very rare. It has usually been reported with suprofen (SEDA-12, 89), but flurbiprofen and ibuprofen have also been implicated (SEDA-18,100). 

Abraham PA, Halstenson CE, Opsahl JA, Matzke GR, Keane WF. Suprofen-induced uricosuria. A potential mechanism for acute nephropathy and flank pain. Am J... 

Strom BE, West SL, Sim E, Carson JL. The epidemiology of the acute flank pain syndrome from suprofen. Clin Pharmacol Ther 1989 46(6) 693-9. 

Example A study in 1,219 patients of the ATHENA (AIDS Therapy Evaluation National Centre) cohort of patients infected with HIV receiving antiretroviral therapy in the Netherlands showed a frequency of urological symptoms (including nephrolithiasis, renal colic, flank pain, hematuria, renal insufficiency, or nephropathy) of 8.3 per 100 treatment-years for indinavir compared to 0.8 per 100 treatment-years for other HIV protease inhibi-... 

Data from the decade of 1940-1950 reviewed by Simon et al [7]in 1990 indicate an incidence of crystalluria of 0.4 to 49%, hematuria (with or without flank pain) of 1 to 32%, oliguria, anuria, or azotemia of 0.4 to 29%, and renal stones of 0.4 to 20%, for an overall incidence of renal toxicity (excluding crystals) between 1 and 32%. For a number of reasons detailed elsewhere [7], these early data are difficult to assess. However, even with the use of preventive measures such as urine alkahnization, renal toxicity was 2% [7], and the incidence of gross hematuria and microscopic hematuria despite high fluid intake were 2-3% and 24%,... 

Figure 1. Sulfadiazine nephrotoxicity (crystalluria and acute renal failure). 35 year old man with AIDS and cerebral toxoplasmosis treated for 33 days with 4-6 g/dayofsulfadiazine.The patient received oral hydration and possibly had an episode of transient renal impairment during days 8-13. By day 29 of treatment, crystalluria, hematuria, flank pain, renal calculi, and acute renal failure developed. Urine was alkalinized late in the course.

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