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

The patient, an 18-year-old woman, visited a local doctor complaining of right flank pain. Characteristic findings obtained by X-ray examination suggested milk of calcium renal stone in the calyceal diverticulum of the right kidney, she was introduced to our clinic on February 16, 1989. Although examinations on admission showed no urinary tract obstruction or renal function disorders, since she repeatedly suffered from flank pain, we decided to remove the stone percutaneously and widen the mouth of the diverticulum. Conventional percutaneous nephrolithotripsy methods were used to endoscopically remove the stone but we were unable to ascertain the mouth of the calyceal diverticulum. Thus, we removed the nephrostomy tube. The stone was composed to 83% calcium oxalate and 17% calcium phosphate. She was released from the hospital with no particular postoperative complications and at present the flank pain has disappeared. Percutaneous treatments against milk of calcium renal stone are discussed.
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PMID:[Milk of calcium renal stone treated with endoscopic extraction: a case report]. 212 7

Perinephric abscess is a life-threatening but treatable process. Most infections of the perinephric space occur as a result of extension of an ascending urinary tract infection, commonly in association with nephrolithiasis or urinary tract obstruction. A large portion of the mortality is the result of failure to diagnose this entity in a timely fashion. This failure may be because of the frequently obscure or nonspecific nature of the clinical presentation. Blood cultures as well as urine cultures may fail to identify correctly the bacterial pathogens responsible for the abscess. Perinephric abscess should be considered in the differential diagnosis of any patient presenting with a urinary tract infection that fails to respond promptly to antibiotic therapy, particularly in those known to have anatomical abnormalities of the urinary tract or diabetes mellitus. Consideration of this diagnosis should enter into the differential diagnosis of fever with abdominal pain or flank pain. Early recognition of perinephric abscess and prompt drainage, either percutaneously or surgically, in combination with appropriate antibiotic coverage, should reduce dramatically the morbidity and mortality from this infection.
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PMID:Perinephric abscess: the missed diagnosis. 304 58

To determine the role of ultrasound (US) in patients with acute flank pain and suspected acute urinary tract obstruction, a prospective study was performed on 20 patients comparing US with emergency excretory urography. US was not as sensitive as excretory urography for diagnosing hydronephrosis, for detecting ureteral or renal calcification, or for diagnosing forniceal rupture. Although US is an effective screening modality for hydronephrosis in patients with chronic renal obstruction, it is not useful for evaluating patients with acute flank pain in whom acute obstruction may be present. In this group of patients, excretory urography remains the examination of choice.
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PMID:Ultrasound versus excretory urography in evaluating acute flank pain. 388 90

The clinical and diagnostic features of renal papillary necrosis (RPN) of 27 patients were studied. Diabetes mellitus was the most frequent (56%) condition associated with RPN. Analgesic abuse, sickle hemoglobinopathy and urinary tract obstruction were present in 4 patients each; in 6 of these 12 patients these conditions were present as a coexistent disease with diabetes mellitus. There was evidence of an acute or chronic infection of the urinary tract in 18 patients, as a coexistent condition with another underlying disease that itself can cause RPN in 14 patients and as the only cause of RPN in another 4. Thus, the presence of more than one diagnostic condition which might be implicated in the causation of RPN was present in 15 patients or 55% of the cases in this series. When infection was excluded, six patients or 22% of the cases had two coexisting diseases, each of which has been implicated as a cause of RPN. This observation underlines the multifactorial nature of this entity and might explain why RPN is not encountered more frequently in each of the various primary diseases with which it has been associated. The average age of the patients at the time of diagnosis was 53 years for women and 56 years for men. Only six of the patients were younger than 40 years, and three of these had sickle hemoglobinopathy. The diagnosis of RPN was based on x-ray findings in eight patients, on the histologic examination of papillary tissue in urine in one, and on autopsy findings in the rest. Papillary necrosis was bilateral in three-fourths of the cases. The clinical picture varied. Most of the patients (67%) presented with chills and fever. Flank pain and dysuria were present in 11 patients (41%). As a rule oliguria was rare and progressive uremia was uncommon. In cases diagnosed at post-mortem, the patients had succumbed to infection or to a primary severe extrarenal disorder with the possibility of RPN having been entertained clinically in only half these cases prior to autopsy.
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PMID:Renal papillary necrosis: an update. 703 74

Between August 1982 and May 1988, 503 patients underwent construction of a continent ileal reservoir (Kock pouch) for cutaneous urinary diversion at our university. Stenosis of the afferent antireflux valve resulted in upper urinary tract obstruction in 11 patients (2%). In addition, 2 patients underwent Kock pouch diversion elsewhere and upon referral to our institution they had afferent valve stenosis. To date 13 patients have been identified with this problem. Hydronephrosis was present in 100% of the functional kidneys in these patients. Radiographs of the Kock pouch were uniformly normal without evidence of reflux or other pathological condition. The most common presenting symptom was flank pain in 7 patients (54%) and the most common presenting sign was creatinine elevation above baseline in 7 (54%). Infections recurred with or without sepsis in 5 patients (38%). Ureteroileal anastomotic strictures were not present in any patient. The interval from creation of the Kock pouch to the diagnosis of stenosis ranged from 2 to 75 months (mean 39). All patients underwent endoscopic evaluation of the Kock pouch confirming stenosis of the afferent antireflux valve, and subsequent mechanical dilation of the stenotic valve. Dilation procedures were repeated in 6 patients (46%), 4 of whom subsequently required open surgical revision of the afferent valve. Of these patients 3 are clinically stable and 1 died of the primary malignancy. The remaining 2 patients are clinically and radiographically stable after multiple dilations. Of the 7 patients (54%) requiring only a single dilation 6 are clinically stable and 1 died of the primary malignancy. Stenosis of the afferent antireflux valve of the Kock pouch, previously unreported to our knowledge, is a rare late complication leading to flank pain, hydronephrosis, recurrent infection and elevation of serum creatinine levels. Approximately 50% of the patients respond to a single dilation of the nipple valve. However, most patients who require repeat dilation will need open surgical revision.
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PMID:Stenosis of the afferent antireflux valve in the Kock pouch continent urinary diversion: diagnosis and management. 828 19

Ileal conduit stenosis was diagnosed in 12 patients in the period 1981-1994. The time between urinary diversion and this diagnosis was 7-30 (mean 14) years. The clinical picture, i.e. colicky flank pain and/or fever, was produced by upper urinary tract obstruction. Intravenous urography, loopography and looposcopy were used in diagnosis. Treatment consisted of removal of the conduit and replacement by a new ileal loop or a continent reservoir, or partial resection with or without ureteric reimplantation. Light microscopy of the removed conduits showed severe, sometimes transmural inflammation with submucosal fibrosis. Transmission electron microscopy (TEM) demonstrated reduced height of microvilli, presence of glycocalyceal bodies and an increased number of lysosomes. Other subcellular structures were intact. The pathogenesis of the stenosis is obscure. Microvascular insufficiency, infection in conjunction with exposure to urine, reaction to some noxious agent in the urine or immunologic causation have been proposed. This late stenosis seems to arise only when ileum is used as conduit. Its insidious course calls for lifelong observation of the upper urinary tracts in these patients.
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PMID:Ileal conduit stenosis--an enigma. 883 50

Acute urinary tract obstruction, a common disease in daily practice, often requires performance of emergency intravenous urography (IVU). However, the spectrum of urographic abnormalities seen with acute obstruction has not been thoroughly addressed. The purpose of this study was to explore the IVU findings in patients with acute urinary tract obstruction. Records of 380 patients who underwent IVU in our hospital during a 6-mo period were reviewed for IVU evidence of acute urinary tract obstruction. Of the 380 patients, 53 (14%; 39 men, 14 women; average age = 43 yr) had acute urinary tract obstruction. All obstructions except one were located in the lower one-third of the ureter. The causes of acute urinary obstruction included ureteral stones in 34 (64%), ureteral edema or lucent stones in 16 (30%), neoplasms in 2 (4%), and inflammatory disease in 1 (2%). Abnormal radiologic findings were hydroureter in 46, nephropyelographic delay in 36, hydronephrosis in 35, interureteric ridge edema in 11, persistent dense nephrogram in 6, urine extravasation in 5, vicarious excretion in 1, striation in 1, and stricture in 1. Radiographic results were normal in one patient. The most common clinical indications of acute ureteral obstruction are flank pain and hematuria, and calculi are the major cause. In one-third of patients, radiopaque calculi are not detectable with IVU during acute urinary tract obstruction. A careful and thorough evaluation of the IVU should be performed in patients with clinical indications of acute urinary obstruction.
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PMID:Radiologic findings in acute urinary tract obstruction. 925 84

Unenhanced helical computerized tomography (UHCT) has recently evolved as an accurate imaging modality for determination of the presence or absence of ureterolithiasis in patients with acute flank pain. Functional renal scintigraphy is considered the gold standard for urinary tract obstruction. The objective of this study was to correlate the secondary signs of urinary obstruction on UHCT with findings of functional renal scintigraphy. UHCT was performed in 30 patients admitted to the emergency room with acute flank pain. All patients had a calcified urinary stone identified on UHCT. The location of each urinary stone was classified as ureteral or in the ureterovesical junction. The presence of secondary CT signs of ureteral obstruction was determined for each patient. After oral or intravenous hydration, a technetium-99m diethylene triamine penta-acetic acid renal scan was performed in all patients within 12 h of the CT scan. Follow-up delayed scintigraphic images were obtained at 2 h and 24 h in patients with evidence of ureteral obstruction. The sensitivity, specificity and predictive values of each possible combination of CT findings were determined by comparison with the scintigraphic results. The distal ureter was the most common location for a calculus on UHCT, followed in frequency by the ureterovesical junction, proximal ureter and mid-ureter. The renograms showed high-grade, unilateral obstruction in 12 patients, indeterminate scans in five patients and normal renograms in 13 patients. The sensitivities and specificities of individual CT findings ranged from 50% to 75% and from 8% to 69%, respectively. Perinephric stranding gave the highest positive predictive value (PPV) for obstruction (69% including indeterminate renograms). None of the individual CT findings showed a statistically significant correlation with scintigraphic findings. A combination of one or two positive CT findings had a PPV of only 25% for obstruction. A combination of three or four positive CT findings gave a PPV of 70% for obstruction. Our preliminary study shows that secondary CT signs of ureterolithiasis correlate poorly with the scintigraphic findings and that they do not permit evaluation of the functional status of obstructed kidneys. Even a combination of the most frequent CT findings has a low predictive value, i.e. does not allow a decision to be made as to the most suitable treatment. Therefore, renal scintigraphy should be performed in conjunction with UHCT in all patients with ureteral calculi.
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PMID:The role of renal scintigraphy and unenhanced helical computerized tomography in patients with ureterolithiasis. 1080 18

Ultrasound has emerged as the primary imaging modality in conditions where either renal obstruction or renal medical disease is suspected on the basis of clinical and laboratory findings. In urinary tract obstruction, pathophysiologic changes affecting the pressure in the collecting system and kidney perfusion are well understood and form the basis for the correct interpretation of real-time US and color Doppler duplex sonography (CDDS). Ultrasound is very sensitive for the detection of collecting system dilatation ("hydronephrosis"); however, obstruction is not synonymous with dilatation, as either obstructive or nonobstructive dilatation may be present. To differentiate these conditions, CDDS with measurement of the resistive index (RI) in the intrarenal arteries is extremely helpful, as obstruction (except in the peracute stage) leads to intrarenal vasoconstriction with a consecutive increase of the RI above the upper limit of 0.7, whereas nonobstructive dilatation does not. Diuretic challenge to the kidney may further enhance these differences in RI between obstruction and dilatation. Based on these findings, the present value of US and CDDS in the assessment of the patient with flank pain or renal colic is suggested, especially with respect to promising results for spiral CT and based on cost analysis. In renal medical disease, distinguishing different pathologic conditions using gray-scale US and CDDS (RI) criteria is still very difficult. Nevertheless, US is the fist-line imaging modality in the patient with renal insufficiency.
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PMID:Ultrasound of the kidney: obstruction and medical diseases. 1170 20

A 72-year-old non-diabetic uremic woman underwent right nephrectomy for urolithiasis at the age of 50. Because pyuria, fever, chilliness and left flank pain developed during preparing for arteriovenous fistula, she was admitted to National Cheng Kung University Hospital. Renal cell carcinoma (RCC) complicated with emphysematous pyelonephritis (EPN) was diagnosed and immediately treated with antibiotics and CT-guided percutaneous catheter drainage. Cultures of pus and blood yielded Escherichia coli. She received left radical nephrectomy later for the control of persistent sepsis and removal of left renal tumor. The pathology of the tumor was composed of a glandular arrangement of granular cells with the occasional atypism, and renal parenchyma had been totally replaced by RCC. The non-tumor part of the kidney showed chronic pyelonephritis. Five months later, multiple metastases developed. We reported this first uremic case with EPN and RCC, but without diabetes mellitus and urinary tract obstruction. The gas formation may be due to large RCC, which caused impaired tissue perfusion and E. coli infection.
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PMID:Renal cell carcinoma complicated by emphysematous pyelonephritis in a non-diabetic patient with renal failure. 1218 10


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