Nephrolithiasis ( renal calculus ) and kidney pain ( renal colic )

One minute a man is sitting quietly, then kidney pain has him writhing on the floor. That story is enough to insert the "kidney" into the sentence - nothing much else will produce such a sudden severe back ache.

Kidney stones are almost three times as frequent in men, compared to women (who get more gallstones.)

In keeping with the male incidence, the traditional treatment to help a stone on its way was a bottle of beer and a skipping rope. Beer kills pain and makes one pee.

Although 80% are calcium stones and will show on a plain X-ray, a CT scan is usually done these days.

You will be assessed for blocked ureter, as prolonged obstruction can lead to kidney damage.



treatment will usually be pain relief, if the stone is small and expected to pass.

Otherwise, the urologists have lots of techniques ranging from breaking the stone up with ESWL to fetching the stone through your passage, or creating their own passage via a tiny incision in your back, tunnelling directly to the kidney.



Reflex paralytic ileus is a complication of this kidney pain. Your tummy would swell up dramatically.

The paralysed large and small bowel fill with air but are not dilated over 3cm. Your Abdomen X-ray might look something like this (but not so bad)...

When hydronephrosis occurs gradually, you may have no symptoms or experience attacks of dull aching discomfort in the flank, between your ribs and hips.

Pyelonephritis ( kidney infection ) and much less severe kidney pain

I do my own urine microscopy in the office, and examine nearly every urine infection. Many times, a person is complaining of passing urine frequently and painfully, but has no backache - yet there will be white blood cell casts in their urine.

The white cells are neutrophil granular leukocytes, which fight infection.
Casts are tightly packed rectangular clumps of these, compressed into this shape in the collecting tubules of the infected kidney.

Pathology services seldom report these casts, unless specifically asked to.

Kidney infection symptoms are backache and fever. The pain is at the level of the lower ribs, rather than in the small of the back.

Elderly people with urinary tract infections often get general symptoms such as confusion, giddiness and weakness, rather than the above complaints. Strong smelling urine may be the only indication of a UTI.



Always take a small sample of freshly passed urine, when you visit your doctor with any of these complaints. The stick tests usually done, are very quick and useful.

Urine microscopy is needed if the stick shows pus cells in a woman, as these may just be from vaginal mucus. If a lot of large flat vaginal skin cells are present, the pus cells are likely to also be contaminants.

The stick also cannot tell if WBC casts are present.

The distinction between kidney infection and cystitis is important, as kidney infections need a longer course of treatment.

Microscopic examination of the urine may be capable of indicating when bleeding is from the kidney or bladder. Dysmorphic red blood cells from the kidney vary ++ in their shape and size.

Renal carcinoma - sinister kidney pain

Urine testing is good. Take a sample to your doctor. Be proactive.

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