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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of cases is presented which illustrates unusual aspects in the presentation, diagnosis, and management of renal cell carcinoma. The entire "classic triad" of flank pain, gross hematuria, and palpable mass was not present at the time of diagnosis in any of the patients. Moreover, in only three patients did the initial clinical findings raise the suspicion of renal cell carcinoma. A diagnosis of polycystic kidney disease, cardiac failure, glomerulonephritis, analgesic abuse, and perirenal hemorrhage obscured the primary diagnosis in the other five patients. In four patients the tumor was probably present from 3 to 12 years before detection. These findings emphasize that knowledge of the hematologic, humoral, immunologic and vascular abnormalities induced by this tumor may provide a clue to early diagnosis. The systematic use of excretion urography, nephrotomography, ultrasonography, renal scanning, renal arteriography and cyst puncture then may allow the accuracy of radiologic diagnosis of this tumor to approach 100%. Lastly, the therapy of choice for this tumor is radical nephrectomy. Excision of apparently solitary metastases also may sometimes be feasible. However, partial nephrectomy to remove tumor in a solitary kidney was performed in one patient to avoid the need for end-stage kidney treatment. Where nephrectomy renders the patient anephric, chronic hemodialysis and renal transplantation should be considered as potential measures to sustain life. While hormonal agents, chemotherapy, and radiation therapy sometimes provide palliation, their use generally has been disappointing.
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PMID:Renal cell carcinoma: unusual systemic manifestations. 78 64

Herein we review 100 cases of adult polycystic kidney disease. Flank pain was the most common presentation in these cases. In 20% of the patients calculi were noted and 10% had obstruction. The average patient age at death was 57 years. The importance of tomography is emphasized with key radiographic features, such as bilateral large kidneys, inhomogeneous nephrogram, caliceal distortion and poorly defined renal margins. Cystic involvement of the liver and spleen may help to confirm the diagnosis. Differential diagnosis includes bilateral multiple simple cysts, angiomyolipomatosis and bilateral renal carcinomas.
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PMID:Adult polycystic kidney disease: a review of 100 cases. 91 84

Although renal calculi and cyst calcifications occur commonly in patients with autosomal dominant polycystic kidney disease (ADPKD), their true frequency is unknown because it is difficult to distinguish between the two with excretory urography and sonography. A detailed analysis of renal calcifications in ADPKD based on CT findings has not been performed. Accordingly, we retrospectively evaluated clinical and CT findings in 84 patients with ADPKD to determine the frequency of calculi and cyst calcifications, the relationship of these abnormalities to symptoms, and possible factors in their pathogenesis. Of the 84 patients, 53 had both IV contrast-enhanced and unenhanced CT scans and 31 had unenhanced scans only. We examined unenhanced CT scans of all 84 patients for renal calcifications. However, we classified renal calcifications into stones and cyst calcifications in only the 53 patients, because it is often difficult to distinguish between the two when only unenhanced scans are available. Of 84 patients, 18 (21%) had passed renal calculi or had stones treated surgically and 42 (50%) had renal calcifications on CT. Of the 53 patients who had both enhanced and unenhanced CT scans, 19 (36%) had renal calculi on CT. Patients with stones had significantly higher frequencies of previous flank pain (68% vs 35%) and of urinary tract infections (63% vs 18%) than did those without calculi. Cyst calcifications occurred in 13 (25%) of 53 patients and were probably a consequence of cyst hemorrhage. Cyst calcifications were found significantly more often in older patients with larger kidneys and worse renal function. We conclude that renal stones have a high rate of occurrence among patients with ADPKD and are a significant cause of morbidity in this disorder. Cyst calcification is also common in patients with ADPKD, particularly those with more advanced cystic disease.
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PMID:Calcified renal stones and cyst calcifications in autosomal dominant polycystic kidney disease: clinical and CT study in 84 patients. 160 26

A 20-year-old female presented with right flank pain she had felt for two weeks. Colics, dysuria and fever were denied. The father and a sister of the patient were known to have cystic kidneys. Abdominal ultrasound revealed symmetrically enlarged kidneys with multiple cysts. Thus, the diagnosis of autosomal dominant polycystic kidney disease (ADPKD) was made. For a follow-up period of four years renal function has remained normal. An intercurrent urinary tract infection was treated with antibiotics. Blood pressure has been normal over the entire follow-up period. As yet, no specific treatment had to be initiated.
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PMID:[Right abdominal flank pain]. 267 77

A review of 20 polycystic kidney disease patients in admitted to Kaohsiung Medical College Hospital is herein reported. In this series 60% of the patients were in the fourth to sixth decades of life at the time of diagnosis. The average age was 50 years. The disease was generally more commonly found in the females than in male subjects. Flank pain and gross hematuria was the most common presenting symptom in these cases. In 70% of the patients hypertension were noted, besides 55% of patients have associated liver cysts and 9% of the patients have associated pancreatic cystic diseases. In a comparison of ultrasonography, CT scans, renal angiography, intravenous pyelography and retrograde pyelography in the evaluation of polycystic kidney disease, it was found that CT scans and ultrasonography had more than a 90 per cent diagnostic accuracy rate, while intravenous pyelography had only a 30 percent accuracy rate. Because of improved treatments such as antibiotic and hemodialysis techniques the five-year survival rate of patients, with polycystic kidney diseases, may be increased.
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PMID:[Diagnosis and treatment of adult polycystic kidney disease]. 277 66

A case of renal angiomyolipoma originating from polycystic kidney with horseshoe kidney is reported. A 32-year-old woman visited our hospital with the complaint of proteinuria. with computerized tomographic scan and further examinations the patient was diagnosed as having renal angiomyolipoma with tuberous sclerosis. The tumor originated from a polycystic horseshoe kidney. Three weeks later, she complained of right flank pain and was diagnosed with spontaneous rupture of the angiomyolipoma. Right heminephrectomy was performed and histological examination confirmed the preoperative diagnosis. Some discussion is made on the characteristics and treatment of renal angiomyolipoma, and the statistics on renal diseases with tuberous sclerosis in Japan are presented.
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PMID:[A case of angiomyolipoma originating from polycystic kidney with horseshoe kidney]. 343 97

A 60-year-old woman, who had been receiving chronic hemodialysis for chronic renal failure due to polycystic disease for 7 years, was admitted to our hospital with the chief complaints of right flank pain and high-grade fever on February 3, 1986. She had a family history of polycystic kidney disease and her elder sister has been undergoing chronic hemodialysis. The patient has had repeated episodes of urinary tract infection. The right markedly distended kidney was palpated with severe tenderness, and the performance status was poor. Computerized tomography showed the right kidney enlarging beyond the median line, but localization of the infected cysts was not clear. The 7-day intensive antibiotic therapy had no beneficial effect. On the 8th hospital day, percutaneous drainage, which was carried out for a large cyst with low-level echoes using ultrasonic guidance, yielded 600 ml of hemopurulent fluid. Bacterial culture of the aspirated fluid was positive for Escherichia coli. As the clinical symptoms did not improve after the 8th day, 10 Fr. catheter placement, percutaneous drainage and catheter placement were added for other cysts containing hemopurulent fluid. Although hematopyuria persisted, the patient became afebrile and the right kidney became smaller and softer. Both catheters were removed on the 30th hospital day. Repeated computerized tomography or ultrasonography revealed a few hyperdense or hyperechoic cysts in the right kidney. However, no recurrence of high-grade fever or right flank pain has been seen for 3 months. Ultrasonic-guided percutaneous drainage has a great potential for patient care of infected cysts in polycystic kidney disease.
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PMID:[Successful percutaneous drainage for infected cysts in polycystic kidney disease in a case of chronic hemodialysis]. 366 43

Unenhanced abdominal CT scans of 35 patients with autosomal dominant polycystic kidney disease (ADPKD) showed multiple high-density (58-84 HU) renal cysts in 42.9% of patients, occasional high-density cysts in 25.7%, and no high-density cysts in 31.4%. These high-density cysts were usually subcapsular and were more frequent in patients with markedly enlarged kidneys and flank pain at the time of CT. Several were found to contain altered blood on pathological analysis. Follow-up CT often showed a reduction in cyst densities, although some cysts developed mural calcification and calcification of their contents. High-density cysts are probably produced by cyst hemorrhage. This may occur randomly as part of the natural history of the disease or may result from minor trauma to the enlarged kidneys. Renal carcinomas occur rarely in ADPKD and may occasionally be hyperdense. However, high-density cysts may usually be distinguished from carcinomas on CT by their smooth contours, sharp interfaces with renal parenchyma, homogeneity, and lack of contrast enhancement.
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PMID:High-density renal cysts in autosomal dominant polycystic kidney disease demonstrated by CT. 396 36

Fifty-three symptomatic adults with autosomal dominant polycystic kidney disease were studied retrospectively for a mean follow-up of 12 years (range 10 months to 33 years). Diagnosis was confirmed by either x-ray, ultrasound, laparotomy, or autopsy. Commonest presenting clinical findings were flank pain (30%), hypertension (21%), symptomatic urinary tract infection (UTI) (19%), gross hematuria (19%), and palpable masses (15%). A total of nine patients (17%) progressed to end-stage renal disease. Change in renal function measured using the reciprocal of plasma creatinine plotted against time was linear for each individual patient with a maximum functional decline of 0.7 mg/dL/yr (slope = -0.07). Past the age of sixty renal failure was uncommon. Easily controlled hypertension developed in 64% attended by mild retinopathy. UTIs were common (53%), often recurrent (61%), precipitated by instrumentation in 6 of 14 patients (43%), leading to death in two (33%). Renal calculi were extremely common (34%) and had no defined metabolic cause. The presence of hematuria (64%), gross or microscopic, bore no relationship to the decline in renal function. Pregnancy was normal in these patients with no increase in fetal or maternal morbidity or mortality. We conclude the following: Renal functional deterioration is linear, less than previously reported, and bears no relationship to hematuria. Hypertension is common, easily treated, and causes minor end-organ damage. Renal calculi are frequent. Urinary tract instrumentation often induces infection with considerable morbidity and mortality and must be avoided. Pregnancy is not contraindicated if renal function is normal. The prognosis for survival in this disease is better than previously reported.
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PMID:Autosomal dominant polycystic kidney disease: presentation, complications, and prognosis. 397 15

Nephrolithiasis is an important manifestation of autosomal dominant polycystic kidney disease (ADPKD), which occurs in approximately 20% of patients. It should always enter the differential diagnosis of flank pain in patients with ADPKD. The diagnosis is hindered by the distorted anatomy of the polycystic kidneys and the frequent occurrence of parenchymal and cyst wall calcifications, and requires demonstration of the relationship to the collecting system by intravenous urography and/or computed tomography. Computed tomography is the most sensitive imaging technique for detection of stones or calcifications, whereas intravenous urography is the most sensitive for visualization of the intrarenal collecting system. Precaliceal tubular ectasia can be detected in 15% of patients with ADPKD and nephrolithiasis, but this association may not be specific to ADPKD. The composition of the stones is most frequently uric acid and/or calcium oxalate. Metabolic factors are important in their pathogenesis. Distal acidification defects may be important in a few patients, while an abnormal transport of ammonium, low urine pH, and hypocitruria are the most common abnormalities. The treatment of nephrolithiasis in patients with ADPKD is not different from that in patients without ADPKD. Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy in patients with early disease and normal renal function are not contraindicated.
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PMID:Renal stone disease in autosomal dominant polycystic kidney disease. 821 89


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