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- Wed Mar 07, 2007 11:38 pm
My mother is white, 65 yo woman with a history of HTN managed by ACEI (Altace) and hyperthyroidism (now normal) that has had left flank and left mid back pain since May of 2006. In June 2006 she had a urinary tract infection which was treated with bactrim. However, this intensified the pain. She stopped taking the antibiotic and her acute pain lessened. Her left side pain has increased gradually over the insuing months. Her right mid back has now begun to hurt as well although not as bad as the left. She describes her left side pain as extreme soreness with occassional sharp, stabbing bursts which can wake her from sleep with SOA. She has had abdominal MRI and cardiolite stress test in the last two months that were unremarkable. She recently went to the ER when advised by her immediate care center during one of her flares ups.
Her blood test revealed the following: (2/11/07)
Occult blood 1.0 + abnormal
epithelial cells 5-10 abnormal
D-dimer 564 abnormal
CO2 33 slightly high (end of normal 32)
K+ 3.4 slightly low (3.5-5.0)
Cl- 95 low (end of normal 100)
Folic acid 20 abnormal (3.3-12.4)
Neutrophils 79.1 slightly high (49-79)
BUN/creatinine ratio 23.8
The chronic pain makes it difficult to sleep and she is getting frustrated with the various physicians/NPs that have not seemed to diagnose/treat the problem. Lately, she has felt a general malaise and fatigue with occassional +1 pedal edema at night. She occassionaly complains of leg pain as well.
It seems to me that she has a clinical presentation of glomerulonephritis or pyelonephritis. Could there be any other possible diagnoses likely, for example abdominal arotic aneurysm?
If is renal what can be done to help relieve the pain?
| Dr. Chan Lowe
- Thu Mar 08, 2007 3:05 pm
There are a few possibilities of your mother's pain. The blood in her urine may be due to infection that has not cleared or possibly kidney stones. I would tend to favor kidney stones over infection as generally infections going on for that long would be quite severe and have other symptoms of fever and dysuria.
Her electrolytes are essentially normal. I would not be concerned about these. Her kidney function appears to be normal based on her creatinine and BUN.
I would recommend a few tests. 1) A complete urinalysis and culture to assess for infections. 2) a spot calcium/creatitine urine test to look for elevated urine calcium which can cause blood/pain even without overt kidney stones. 3) If the pain continues to be severe a renal ultrasound may be helpful but the best test for kidney stones is a CT scan.
Continued follow up with her doctor is important. She may also want to see a kidney specialist or urologist to help guide the work up.
Hope this helps.