ABSTRACT
Renal pain may be a mild, dull ache or excruciatingly severe, demanding powerful, injectable narcotic treatment and admission to hospital. Typically it is located in the side below the rib cage and may spread to the front of the abdomen, and to the testicle in the male and vulva in the female. Quite often, vague central backache may be the only indication of renal disease. Since this symptom is extremely common – almost universal at some time in one’s life – this sort of renal pain may give rise to understandable misdiagnosis. Common causes of flank pain include urinary tract stones, tumours and obstruction to the urinary tract by inco-ordinate peristalsis. Misdiagnosis is easy, and therefore imaging of the urinary tract – ideally during an episode of pain – is required. Intravenous urography (kidney X-ray after intravenous injection of contrast which delineates the kidneys, collecting system and bladder) is the mainstay of investigation, combined if necessary with ultrasound examination. A particular problem may be presented by pelvi-ureteric junction obstruction in which the renal pelvis (see p 141) and proximal collecting system become dilated owing to inco-ordinate peristalsis at the junction of ureter and pelvis. Pain may be intermittent, the anatomical appearances may appear normal or relatively normal in some patients when pain is absent, and it is easy to confuse normal variants (such as a renal pelvis lying mainly outside the kidney) with the condition.
