Left Flank Pain. Low GFR

[janjel]

I'm an LPN with SLE. For months I've had a sharp pain in my left side under the lower ribs. In April they did a chest xray and CT scans to see if it was my lungs. The only thing that showed up was some swollen lymph nodes. The blood test showed elevated C reactive proteins, and sed rate and a GFR of 56. The pain eased off and I let it drop. Well, now it's back, and over the last couple of weeks it's gotten really bad. They've given me lortab, and it doesn't touch it. I had an abdominal CT scan and it was normal. My GFR is now 55 and I have an elevated C-reactive protein again. I don't know if it's related to the pain, but it's the only thing I've been able to see. The doctor I work with is stumped. He doesn't know why I have this pain and my rheumatologist ignores me. He's the only one in the area, so I have no other recourse. If you have any suggestions about the cause of the pain please help me out. I don't know if the GFR is related or not. My family doctor is willing to listen to any suggestions I can find for the cause of the pain.
Thank you.

[Tom Plamondon PA-C]

Thanks for you patience.

You presented a history of SLE, GFR at 56-55, left sided lower rib pain recurring.

Regarding the pain, is it tender to touch; does it change with movement; does it increase with deep respirations.

It would be prudent to think about a musculoskeletal cause or a pleuritis etiology (inflamation of the lung or inner chest wall lining). Occasionally, SLE "flare-ups" present with pleuritic pain.

Regarding the kidney concerns, commonly SLE patients have kidney disease. It would be worthwhile to get a UA with microscopy, Bun, Cr, and a 24 hour urine if protein present on the UA.

Your family physician may consider SLE as a source of both problems and test and treat accordingly including consult to nephrologist.

Let us know how things go.