Kidney Pain

The term ‘Kidney Pain’ or ‘Renal pain’ is used randomly whenever a flank pain is felt. This necessarily need not be a pain from the kidney. A variety of causes can always be confused with kidney pain.

Consequently, to differentiate the cause of the pain, it is pertinent to understand where kidney exactly is placed in the body.

Image1 & 2: Kidney pain is felt in the flanks. ^{[3, 4]}

Kidney Location (Anatomy)

The kidneys are located in the abdomen (below the diaphragm), nearer to the back side. They are bean shaped organs. Most of it is protected by the back end of the ribs. The right kidney is pushed down slightly by the right lobe of liver. To know about the liver position in the body, kindly refer to ‘Liver Location’.

Surrounding the kidneys there is a layer of fat which further helps in protecting it from blunt injuries.

 

Image 3 (a,b,c) : The kidneys when seen from behind (back)(surface anatomy) . It can also be noted that its position is corresponding to T12 (Thoracic) vertebra to L3 (Lumbar) vertebra. ^[5]

Image 4 & 5: From the above image, it is clearly visible that kidneys are placed more towards the back of the body in both male and female. The tubes which connect the Kidneys to the bladder are called as ‘Ureters’ and that which passes the urine from the bladder to the outside is called a ‘Urethra’. ^[6]

Kidney location in relation to four quadrants of abdomen

Functions of the Kidneys

• Helps in regulating the fluid volume inside the body.
• Helps in regulating the acid base balance inside the body.
• Removes the toxins, drugs and waste products from the blood.
• Helps in regulating the electrolyte balance in the body.
• Produces hormones and neuro-transmitters.^[13]

Kidney Pain Location

Where is Kidney Pain felt?

Image 6: The colored areas in the image are the region in which renal pain/ kidney pain/ flank pain occurs. ^[7]

Referred pain pattern in kidney pain and its areas in yellow color

What does kidney pain feel like?

Generally the pain from kidneys is felt as dull aching pain[2]. Occasionally when there is a sudden obstruction of the ureters due to a stone, the ureters try to push it downward by its own movement. This may cause a sharp pain (renal colic) ^[1].

What causes Kidney pain/ flank pain?

The pain which is referred to as kidney pain may sometimes not be from kidneys at all.

What are the possible conditions causing similar pain? Differential diagnosis

Condition	Site of Pain	Clinical findings
Appendicitis	Near to the umbilicus and radiates to the right lower quadrant of the abdomen.	Pain Nausea Vomiting Anorexia Tenderness at Right lower quadrant.
Acute urinary retention	Lower abdomen	Lower abdomen pain Inability to urinate Swelling/enlarged and full bladder can be seen and felt on the lower abdomen.
Cystitis	Lower abdomen	Lower abdomen/ Suprapubic pain Painful urination (Dysuria) Increased frequency of passing urine (Frequency) Compelling urge to urinate (Urgency) Blood in urine (Haematuria)
Diverticulitis	Left or Right lower quadrant of the abdomen	Constant pain in the left or right quadrant of the abdomen. Nausea Vomiting
Endometriosis	Left or right lower quadrant of the abdomen	Painful periods (Dysmenorrhoea) Pain with intercourse Pain while passing urine or bowel movements Heavy periods (menorrhagia) or bleeding in between periods Infertility Nausea, vomiting, diarrhoea, constipation
Infectious colitis	Right or left lower quadrant of the abdomen. But may present as whole abdomen pain.	Pain abdomen Diarrhoea Fever Chills
Lower back pain	Pain in the lower back	Pain associated with position, positional change and exercise.
Nephrolithiasis	Pain maybe in the flanks, lower abdomen or back	Pain maybe dull aching or sharp Pain maybe continuous or intermittent Nausea, vomiting
Pyelonephritis	Flanks, lower abdomen or back	Dysuria Frequency Urgency Haematuria Tenderness just over the kidney area. (Costo-vertebral angle)

Table: Differential diagnosis for flank pain. The above given are conditions that may resemble kidney pain. ^{[8, 9, 10, 11, 12]}

So What Causes Pain in Your Kidneys?

Pain in the kidneys can be due to any obstruction in the urinary tract (Kidneys, ureters, Bladder, urethra), disease of the urinary tract, congenital abnormalities or malignancies. ^{[2, 14, 15, 16]}

Condition	Site of pain	Clinical findings
Polycystic Kidney disease- Multiple cysts in the kidneys [17]	Back pain or abdominal pain	Palpable lump on both sides in the upper abdomen. Hematuria Frequent urinary tract infections
Hydronephrosis- Swelling of the kidney	Upper back or flanks	Pain due to the obstruction in the urinary tract that has led to the swelling. [18]
Pyelonephritis- Infection of the kidney [20]	Flanks (Left, right or both)	Dull, aching pain Nausea Vomiting Fever, Chills Anorexia
Rupture of cyst in kidney [19]	Flanks	Pain in the flanks Haematuria Fever
Kidney tumours [19]	Flanks and Upper back	Pain in the flanks Haematuria Fever
Stones in kidney, ureter or bladder [21, 22]	Upper back, flanks, lower abdomen	Dull aching to severe sharp stabbing pain radiating to the flanks, groin and inner thighs. Nausea, Vomiting Haematuria
Urinary tract infection	Lower abdomen	Dysuria Haematuria Frequency Urgency Fever with chills
Glomerulonephritis [23]	Flanks and Upper back	Generalized and pedal oedema Haematuria High blood pressure
Renal vein thrombosis [24, 25]	Lower back and sides of abdomen	Abdomen pain Fever Haematuria Decreased urine output

Symptoms & Signs of Kidney disease

The symptoms and signs mentioned below are usually found with kidney or urinary tract diseases. It is important to get a medical attention to diagnose the exact cause for appropriate management of the condition^[2].

• Fever
• Pain
• Dysuria- Painful urination.
• Haematuria- blood in the urine
• Frequency- Increased frequency of passing urine
• Urgency- Compelling urge to urinate
• Nausea
• Vomiting
• Anorexia
• Chills
• Edema – Swelling in the ankles. Sometimes there can be generalized oedema which occurs throughout the body.

How is Kidney Pain diagnosed?

Diagnosis over kidney pain involves a proper history evaluation and examination by the doctor. In most conditions, the doctor will have an initial suspicion regarding the cause of the pain. This will further be confirmed or excluded by appropriate investigations which will be advised. The usual investigations involved in diagnosis of kidney pain include the following. ^[2]

• Complete blood count
• Urine routine examination
• Urine culture and blood culture
• Kidney function tests- Blood urea, serum creatinine, blood urea and nitrogen
• Pregnancy test
• Ultrasonography of the abdomen and KUB region
• Abdomen- CT/ MRI

Treatment

The treatment of kidney pain depends on the cause of the pain itself. If it is a stone, the stone has to be removed. If it is an infection, then antibiotics needs to be given. Symptomatic treatments are also provided such as pain killers and antipyretics. Certain conditions like malignancy would require extensive surgeries to be done. ^[2]

General measures

• In kidney stones, avoid chickpeas, cauliflower, carrots, turnips and increase intake of watermelons, grapes, Cranberry juice, grapefruits etc^[26].
• Avoid alcohol which can aggravate the pain.
• Drink more water daily.
• Plenty of rest.

References:

1. Dave, C., MD. “Nephrolithiasis.” Medscape. Updated: Aug 07, 2016. http://emedicine.medscape.com/article/437096-overview
2. https://www.medicinenet.com/kidney_pain/article.htm
3. Image 1: https://www.reference.com/science/kidney-located-db85177cfeb39f1d
4. Image 2: http://hillclinic.com/en/laser-treatment-nephrolithiasis/
5. Image 3: http://philschatz.com/anatomy-book/contents/m46429.html
6. Image 4 & 5: https://www.news-medical.net/health/What-is-the-Urethra.aspx
7. Image 6: http://www.lower-back-pain-toolkit.com/back-pain-kidney.html
8. https://www.uptodate.com/contents/image?imageKey=PC%2F106202&source=contentShare&csi=eb1607cf-c744-4cfa-96c5-86cb87fd8fe7
9. https://emedicine.medscape.com/article/1958746-overview#showall
10. https://en.wikipedia.org/wiki/Endometriosis
11. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
12. https://www.emedicinehealth.com/colitis/page2_em.htm
13. https://www.livescience.com/52047-kidneys.html
14. http://www.kidneyfund.org/kidney-disease/kidney-problems/kidney-pain.html
15. http://www.uptodate.com/home. Accessed Jan. 14, 2017.
16. https://www.mayoclinic.org/symptoms/kidney-pain/basics/causes/sym-20050902
17. Diagnosis and management of chronic kidney disease; Scottish Intercollegiate Guidelines Network – SIGN (June 2008)
18. https://www.nhs.uk/Conditions/Hydronephrosis/Pages/Introduction.aspx
19. https://www.mayoclinic.org/diseases-conditions/kidney-cancer/symptoms-causes/syc-20352664
20. https://emedicine.medscape.com/article/245559-clinical#showall
21. http://www.uptodate.com/contents/kidney-stones-in-adults-beyond-the-basics
22. https://emedicine.medscape.com/article/437096-clinical#showall
23. https://emedicine.medscape.com/article/239278-clinical
24. http://www.healthcommunities.com/nephrotic-syndrome-ns/what-is-renal-vein-thrombosis.shtml
25. http://www.healthofchildren.com/R/Renal-Vein-Thrombosis.html
26. https://www.ihealthblogger.com/kidney-pain-location-symptoms-causes-diagnosis-treatment/