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

Ultrasonography and intravenous pyelography (IVP) were compared for their diagnostic value in 65 patients (29 women, 36 men; mean age 57 [19-85] years) thought to have disease of the kidneys or urinary tract (microhaematuria in 16, macrohaematuria in 5, urinary tract infection in 11, suspicion of renovascular hypertension in 6, suspected tumour in 5, suspected nephrolithiasis in 15, and flank pain of uncertain cause in 7). Ultrasound established an abnormal condition in 29, in five of which IVP gave false positive results, false-negative results in three. The false-negative results were an indirect sign of renal artery stenosis in one patient and in one patient each of duplex ureter and cystic ureteritis. Mild hydronephrosis (n = 3), stone in a kidney or the renal calyx system (n = 2) and tumour of the right kidney (n = 1), diagnosed by ultrasound, were not seen by IVP. Concordant results were thus obtained in 70% of cases. Ultrasound examination of the urinary tract gives such reliable results that in many cases an additional IVP is unnecessary.
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PMID:[A comparison of sonography and intravenous pyelography in diseases of the kidneys and urinary organs]. 240 30

The proliferation of imaging methods for the kidney and urinary tract, combined with advances in technology and the introduction of new techniques, has created uncertainty in selecting the most efficient method for evaluating many problems encountered in clinical medicine. The main advantage of nuclear medicine lies in demonstrating the pathophysiology involved. Recent developments in Doppler ultrasound and magnetic resonance imaging with different pulse sequences and paramagnetic contrast agents also have shown promise for imaging physiological processes. However, there is little literature to support their advantage over nuclear medicine procedures in many common clinical situations. The complementary nature of nuclear medicine studies in the imaging evaluation of hydronephrosis, renal artery stenosis, flank pain, renal mass, pyelonephritis, and the transplant kidney is reviewed.
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PMID:Correlative imaging of the kidney. 797 58

(1) Renal colic is an acute syndrome involving unilateral flank pain, linked to an obstruction in the upper urinary tract. The pain is often intense. After having considered other diagnoses and checked for signs of complication (fever, oligoanuria), the first step is to control the pain; (2) Which non-invasive treatments have a positive risk-benefit balance in relieving this type of pain? To answer this question, we reviewed the available evidence, based on the standard Prescrire methodology; (3) According to a meta-analysis of 20 trials, nonsteroidal antiinflammatory drugs (NSAIDs) and strong opioid analgesics have comparable efficacy. The most widely studied NSAID is diclofenac, given intramuscularly at a dose of 50 mg or 75 mg. Pethidine is the best-assessed strong opioid, given intramuscularly at a dose of 50 mg to 100 mg, which corresponds to about 5 mg to 10 mg of morphine. Morphine is given intravenously; subcutaneous administration is an alternative although it has not been evaluated in renal colic; (4) In clinical trials, NSAIDs were associated with fewer adverse effects than opioids, which cause vomiting in about 20% of patients (versus about 6% with an NSAID); (5) NSAIDs expose patients to a risk of functional renal impairment, especially in patients with heart failure, renal artery stenosis, dehydration, renal impairment or ongoing treatment with a nephrotoxic drug, and the very elderly. NSAIDs should never be used during pregnancy; (6) According to one trial in 130 patients, the analgesic effect of the morphine and NSAID combination was greater than either agent used alone, in about 10% of patients; (7) Paracetamol has not been evaluated in comparative trials of renal colic, even for moderate pain; (8) Scopolamine is the only antispasmodic to have been evaluated in a comparative trial. Adding scopolamine to morphine did not seem to provide additional efficacy; (9) Other drugs, which have not been adequately tested as of early 2009, have no documented benefit in the treatment of the pain associated with renal colic; tamsulosin, nifedipine, desmopressin; (10) Among the non-drug measures tested, local active warming, taking care to avoid burns, was effective against pain according to one trial; pain was reduced by at least 50% using a device delivering 42 degrees C to the abdomen or lower back; (11) In pregnant women, morphine carries a lower risk of adverse effects than NSAIDs; (12) In practice, the treatment of renal colic is mainly based on taking an NSAID, or morphine when the NSAID does not adequately control the pain or when it is better to avoid using NSAIDs.
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PMID:Renal colic in adults: NSAIDs and morphine are effective for pain relief. 1988 96

Fibromuscular dysplasia (FMD) is an uncommon disorder, accounting for less than 10% of cases of renal artery stenosis, and typically presenting with hypertension in young women. This article reports the case of a previously healthy 37-year-old man presenting with acute-onset, severe, bilateral flank pain. Initially treated for ureteral colic and urinary tract infection, he was transferred to the nephrology clinic upon recognition of a rising serum creatinine. He was found to have FMD of bilateral renal arteries with a stenotic pattern on the right side and a dissecting aneurysm on the left side with resultant infarctions in both kidneys. On the basis of negative serological markers of vasculitis, a diagnosis of FMD complicated by bilateral renal infarctions was made. A stent was placed to the right stenotic renal artery, which resulted in sufficient lumen patency. No invasive procedure was performed on the other side owing to the complexity of the lesion. After 2.5 years of follow-up, the patient remained in good condition with normal renal function and adequate blood pressure control with dual antihypertensive therapy. Renal infarction complicating FMD of renal arteries is rare in the literature, with most of the cases having causative cardiovascular risk factors including coagulopathy, ischaemic heart disease, atrial fibrillation or structural cardiac abnormalities, none of which was present in this case. In conclusion, FMD may occur in atypical asymmetric presentations causing renal infarctions in both kidneys. Radiological interventions in such cases should focus on stabilizing renal lesions and renal function.
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PMID:Bilateral renal infarctions complicating fibromuscular dysplasia of renal arteries in a young male. 2162 38

We present the case of a 21-year-old man who developed a renal artery pseudoaneurysm following a 7-foot fall onto his back. He initially presented with gross hematuria, left flank pain, and back pain. He was observed in the hospital for 3 days and discharged. One week later, he was readmitted with headache, nausea, vomiting, seizure activity, and hypertension. Contrast-enhanced computed tomography of the abdomen showed a left renal artery pseudoaneurysm with associated arterial narrowing and delayed ipsilateral renal enhancement. He underwent percutaneous stent-graft placement with resolution of the pseudoaneurysm. He was free of complications and normotensive off antihypertensive medications after 36 months of follow-up. Renal artery pseudoaneurysms are rare and under-recognized complications of blunt abdominal or back trauma that can cause hypertension. Imaging modalities in renovascular hypertension have focused on detecting renal artery stenosis from atherosclerotic disease or fibromuscular dysplasia, with little attention given to renal artery pseudoaneurysms. In addition, first-line treatment for renal artery pseudoaneurysms historically has consisted of angioembolization, yet percutaneous stent-graft placement has emerged as an attractive alternative to preserve vessel patency. We discuss the role of imaging in renovascular hypertension with a focus on renal artery pseudoaneurysms and their prevalence, diagnosis, and treatment.
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PMID:Renovascular hypertension associated with pseudoaneurysm following blunt trauma. 2351 97

We describe the case of a young female who presented with hypertension, left flank pain, and hematuria. Workup was done to determine secondary causes of hypertension, which indicated renal artery stenosis. However, the renal angiography did not reveal any focal areas of stenosis. Further investigations revealed delayed renal vein emptying, suggesting extrinsic renal vein compression and leading to a diagnosis of nutcracker syndrome.
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PMID:Nutcracker Syndrome with Hypertension: A Case Report. 3136 99

Flank pain is a common reason for visits to the emergency room. The most common reason warranting hospital visits are urology-related problems. However, there are many other causes, such as musculoskeletal lesions, that difficult to achieve a correct diagnosis. Here, we describe a rare case of flank pain caused by thoracolumbar junction syndrome, accompanying renal artery stenosis. A 54-year-old male with hypertension presented with severe left flank pain for 1 week. Initially, he was diagnosed with left renal artery stenosis by computed tomography and decreased renal function on renal scan (Tc-99m DTPA). Although a stent was inserted into the left renal artery, flank pain persisted with only minor improvement. Through detailed physical examination, he was finally diagnosed with thoracolumbar junction syndrome. After three injections in the left deep paravertebral muscles at the T10-T12 levels, flank pain completely ceased. Clinicians must consider thoracolumbar junction syndrome, when treating patients with flank pain.
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PMID:Thoracolumbar Junction Syndrome Accompanying Renal Artery Stenosis: A Case Report 3213 Aug 42