Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

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

Of 213 patients more than 3 years old with recurrent urinary tract infections new pyelonephritic scars formed only among those with a combination of urinary tract infection and vesicoureteral reflux. Of 61 patients with that combination new renal pyelonephritic scars developed in 7 (11.48 per cent) and severe clubbing in 2. Of 40 patients with vesicoureteral reflux who underwent an antireflux operation new scars formed in 5 and progressive renal damage occurred in 1. Most renal scars (58) were present at initial examination. Neither number of urinary tract infections, number of upper urinary tract infections localized by the bladder washout technique nor attacks of flank pain and fever were seen more often in patients who suffered new scars, and grade of reflux was not a factor. Patients in whom new scars developed during our prospective followup were younger than those who did not have new scars. However, new scars formed after an initial normal excretory urogram in only 1 patient with vesicoureteral reflux and urinary tract infection compared to 4 after an antireflux operation.
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PMID:Pyelonephritic scarring in 213 patients with upper and lower urinary tract infections: long-term followup. 649 84

Chronic lower abdominal pain or flank pain in adults may be associated with vesicoureteral reflux. Although it is well known that renal scarring may occur in adults with vesicoureteral reflux associated with urinary tract infection, renal function may vary significantly when these patients are found to have sterile vesicoureteral reflux. We report 2 cases of lifelong intermittent lower abdominal pain associated with vesicoureteral reflux without damage to the upper urinary tracts. A voiding cystourethrogram should be included in the evaluation of adults with chronic lower quadrant pain or flank pain even if excretory urography and cystoscopy are normal and the urine is sterile.
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PMID:Chronic lower quadrant abdominal pain due to vesicoureteral reflux. 682 67

Six of 14 patients with renal abscess had prior history of urinary tract infection; initial symptoms included fever and flank pain in 12. A drip-infusion intravenous pyelogram was the most sensitive radiologic test, but selective renal arteriography was most specific. Urine cultures were positive in all 14 patients; blood cultures were positive in nine. Six patients were treated with antibiotics alone and eight required surgery. Of the eight, five had pus-filled cavities, one had multiple stones, one had a renal infarct, and one had a resolving abscess. Of six treated with antibiotics alone, one died of unrelated complications and five have demonstrated no pathological renal condition after three to six years.
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PMID:Intrarenal abscess. Report of 14 cases. 699 28

A 47-year-old chronic alcoholic white male with previously normal renal function and no prior history of urinary tract infection developed the sudden onset of fever, bilateral flank pain, oliguria, and deterioration of renal function. Subsequent workup revealed massive pyuria, bilaterally enlarged kidney, and positive urine and blood cultures for E. coli. In spite of successful treatment with appropriate antibiotics and gradual improvement of the patient's clinical status, pyuria and renal failure persisted, necessitating institution of hemodialysis. 8 weeks after admission a renal biopsy revealed renal parenchymal malakoplakia.
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PMID:Renal parenchymal malakoplakia presenting as acute oliguric renal failure. 743 82

We are reporting a young female who presented with a history of right flank pain and urinary tract infection off and on. On investigation, she was found to have a giant fork-shaped ureteral calculus in a bifid ureter. Since her ipsilateral renal unit was nonfunctioning, nephroureterectomy was performed. Such a case of giant staghorn ureteral calculus in a bifid ureter has never been reported in the world literature.
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PMID:Giant staghorn ureteral calculus. 760 65

The presence of stones during an otherwise uneventful pregnancy is a dramatic and potentially serious issue for the mother, the fetus, and the treating physicians alike. The incidence and predisposing factors are generally the same as in nonpregnant, sexually active, childbearing women. Unique metabolic effects in pregnancy such as hyperuricuria and hypercalciuria, changes in inhibitors of lithiasis formation, stasis, relative dehydration, and the presence of infection all have an impact on stone formation. The anatomic changes and physiologic hydronephrosis of pregnancy make the diagnosis and treatment more challenging. Presenting signs and symptoms include colic, flank pain, hematuria, urinary tract infection, irritative voiding, fever, premature onset or cessation of labor, and pre-eclampsia. The initial evaluation and treatment are again similar to those used for the nonpregnant population. The most appropriate first-line test is renal ultrasonography, which may, by itself, allow the diagnosis to be made and provide enough information for treatment. Radiographic studies, including an appropriately performed excretory urogram, give specific information as to size and location of the stones, location of the kidneys, and differential renal function and can be used safely, but the ionizing radiation risks should be considered. All forms of treatment with the exception of extracorporeal shock wave lithotripsy and some medical procedures are appropriate in the pregnant patient. Close coordination by the urologist, the obstetrician, the pediatrician, the anesthesiologist, and the radiologist is required for the appropriate care of these patients.
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PMID:Urinary tract stones in pregnancy. 785 14

Spontaneous ureterocolic fistula is rare and usually caused by urinary calculi. We present the fifth reported case of spontaneous ureterocolic fistula caused by diverticular disease of the colon. Review of these cases revealed a preponderance of women (3:1 ratio), with mean age of 77 years. These patients may have a protracted course before an accurate diagnosis is made (up to 10 years) because of the typical vague presentation. Urologic symptoms predominate, especially urinary tract infection (100%), fecaluria (75%), and abdominal (75%) or flank pain (50%). Barium enema is the most reliable diagnostic test in demonstrating the fistula (75%) compared with intravenous pyelogram (33%) or retrograde pyelogram (25%). The left ureter is usually involved (75%). Surgical intervention is generally directed towards resection of the diseased bowel with primary anastomosis when feasible. Surgical manipulation of the urinary system is unnecessary except for removing a non-functioning, infected kidney. Results of surgery were excellent, with 100 per cent cure and one unrelated mortality on long term follow-up. We recognize the potential for increase in this type of internal fistula, given the increasing lifespan and the established increase in incidence of colonic diverticular disease with advancing age. The correct diagnosis can often be determined preoperatively (75%), and surgical intervention is routinely successful.
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PMID:Spontaneous ureterocolic fistula: a rare complication of colonic diverticular disease. 797 75

A followup study on nonhospitalized spinal cord injury patients using clean intermittent catheterization was conducted to evaluate long-term clean intermittent catheterization for any genitourinary complications, and to institute and evaluate prompt management. A total of 50 patients (36 paraplegics and 14 quadriplegics) was followed for 3 months to 6.5 years (average followup 22 months). All patients had a baseline urodynamic study and renal scan before they were discharged from the hospital. Patients with a reflex bladder and sustained, high intravesical pressures (greater than 40 cm. water) were placed on anticholinergic medication to lower voiding pressures and maintain continence. Those on clean intermittent catheterization and condom drainage were also given alpha-blockers to achieve low pressure voiding and to control autonomic dysreflexia. Of 50 patients 43 (86%) acquired a total of 364 events of significant bacteriuria (10(4) or more colony-forming units per ml.) at a rate of 13.63 infections per 1,000 patient-days on clean intermittent catheterization. Subclinical symptoms for urinary tract infection were noted in 22 of the 43 patients (51%), whereas clinical symptoms for urinary tract infection were recorded in 16 of 43 (37%). These symptoms included fever in 8 patients, chills in 3, hematuria in 3 and flank pain in 2. There were 31 genitourinary complications in 21 patients noted during periodic diagnostic evaluations, with 6 classified as upper tract. Of 50 patients 4 (8%) required rehospitalization for urological problems. One patient died of questionable sepsis. Transurethral sphincterotomy was performed in 15 of the 50 patients (30%) and transurethral prostatectomy was done in 1 for multiple reasons, for example high intravesical voiding pressures, difficult catheterization, repeated symptomatic urinary tract infections or per patient request to discontinue clean intermittent catheterization. Of 7 patients who were catheterized by others 4 elected to discontinue long-term clean intermittent catheterization after an average of 13 months. Overall, 33 patients (66%) discontinued clean intermittent catheterization and 17 are still being followed on a long-term basis. Clean intermittent catheterization is a successful long-term option to drain bladders in spinal cord injury patients who can perform catheterization independently.
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PMID:Clean intermittent catheterization in spinal cord injury patients: a followup study. 848 12


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