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 else3 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)...

Another complication is hydronephrosis. The urinary passages are distended here, due to the stone obstructing the flow of your urine from kidney to bladder.

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

In fact very frequently none at all.
Most times only your bladder is doing the complaining.

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 also be capable of distinguishing whether 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

Kidney tumors are increasingly being found because blood is found on routine urine tests. Back or flank pain are evidence of more advanced disease.

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

It is much more likely that any blood found will come from your bladder, however. Renal adenocarcinoma is fortunately reasonably uncommon.



Recurrent urinary tract infections

Scarring left over from previous kidney infections, can have blocked some tubules in the kidney. Stagnant fluid in such blocked tubules, is an ideal place for germs to grow.

An old urological aphorism is "stasis is the basis."

For the same reason, urine infections become more common as men age, due to prostate enlargement and residual urine in the bladder from incomplete emptying.
They can have 300ml of residual and not be very inconvenienced.

For both sexes, it is well worth while taking a little extra time over passing urine, once it becomes obvious that one's urinary stream is no longer as strong as it used to be.

Get it out now. Our bladder wall is very good at destroying germs, if the walls are touching together.


UTI recurrence in women¹ can also be due to reinfection from below. Healthy vaginal flora help to prevent this, and can apparently be usefully augmented².

Other means of preventing recurrence include about 2 gm of vitamin C per day and a sugar called mannose which blocks the germs from adhering to the bladder wall.
Barley water is a good preventative. There are lots of recipes on the net.
I've found Natures Sunshine "Herbal Diuretic" useful also. This is an Australian product I think, containing juniper berries, parsley leaf, uva ursi leaf, dandelion root and german chamomile flower.
The drug nitrofurantoin is also useful, as it doesn't lead to antibiotic resistance. Germs are either naturally resistant or sensitive, and stay that way. It is sometimes used as a single dose after sexual intercourse (combined with emptying one's bladder then.)

If you are subject to recurrent urine infections requiring antibiotics, keep a sequential list of the drugs prescribed. It is well worth rotating between at least 3 suitable antibiotics, so that your personal collection of resident germs does not build up resistance to any one of them.

Some years ago it was recommended to treat cystitis without first collecting urine for culture of the germs. Opinion is swinging towards doing this as the antibiotic resistance problem is now much worse.




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References and notes for kidney pain page

1. Gupta and Trautner Diagnosis and management of recurrent urinary tract infections in non-pregnant women. bmj 2013 vol 346 30-33
Over 1/3 recur, especially if there is a family history of this. In 2/3 the germ is apparently the same as before, even with recurrence up to 3 years after the first infection! It is worth while having a urine culture test if infection recurs, to make sure it is an infection and not overactive bladder or interstitial cystitis. One more possible preventative for post menopausal women, is vaginal oestrogen.

2. Stapleton et al Randomized, Placebo-controlled Phase 2 Trial of a Lactobacillus crispatus Probiotic Given Intravaginally for Prevention of Recurrent Urinary Tract Infection Clinical Infectious Diseases 2011;52(10):1212–1217


3. Obviously nothing much except a bleeding abdominal aortic aneurysm, something to look for in an older man with no previous kidney stones. Symptomatic abdominal aortic aneurysm misdiagnosed as nephroureterolithiasis (in 24 of 134.) Borrero E1 and Queral LA.Ann Vasc Surg. 1988



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