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 56-year-old male with DM and HTN presented with flank pain and nausea. Review of systems was negative, physical examination was notable for mild hypovolemia and laboratory revealed BUN 51 mg/dl, creatinine (Cr) 5.1 mg/dl (baseline 1.5), Westergren ESR 122 mm/h, fractional excretion of sodium 0.2% and UA positive for blood and protein. Despite volume resuscitation the Cr continued to rise. Urine sediment analysis revealed granular casts, renal tubular epithelial cells and a negative Hansel's stain. Hemodialysis was initiated with Cr 13.7 mg/ dl for dyspnea and dysgeusia. Subsequent laboratory data revealed 2 separate positive anti-GBM antibody titers and prednisone therapy was initiated. Renal biopsy was performed for further diagnostic, therapeutic and prognostic information and demonstrated interstitial nephritis with linear IgG and albumin deposition consistent with diabetic nephropathy. Follow-up antibody titers were negative. prednisone was discontinued and Cr stabilized with conservative therapy. Anti-GBM antibody disease is characterized by circulating IgG antibodies directed against the glomerular basement membrane, specifically the alpha-3 (IV) collagen chain. Anti-GBM nephritis is a rapidly progressive, isolated glomerulonephritis in association with circulating anti-GBM antibodies. A positive immunofluorescence (IF) test is considered diagnostic in the appropriate clinical setting. Therapies include immunosuppressive agents to suppress new antibody production and plasmapheresis to eliminate circulating antibodies. Anti-GBM antibody is not rapidly cleared by steroid therapy and the recovery of renal function is rare if initiation Cr is greater than 7 mg/dl. This case demonstrates that the current ELISA for alpha-3 (IV) collagen is not pathognomonic for anti-GBM nephritis and that renal biopsy with IF for IgG and albumin may be indicated to prevent administration of potentially toxic treatment.
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PMID:Diabetic nephropathy with interstitial nephritis presenting with a false-positive anti-GBM antibody. 1203 99

Malignancy may produce ureteric obstruction. This obstruction may be relieved by inserting a nephrostomy tube. All 31 cases of malignant ureteric obstruction from a single institution were retrospectively analysed. The commonest indications for nephrostomy tube insertion were renal failure (87%) and flank pain with hydronephrosis (13%). The mean serum creatinine levels pre and post insertion were 481 and 170 micromol/l, representing significant improvement (p<0.01). The complication rate was 13%, relating to tube blockage or dislodgement. Survival of patients was significantly worse if their malignancy was not resectable or suitable for chemotherapy (p=0.01). However, incurable patients still survived for a mean of 232 days, and although 46% of this time was spent as an inpatient, it did not differ significantly from the inpatient rate of curable patients (31%, p=0.1). Nephrostomy tube insertion should be considered for all palliative cases of malignant ureteric obstruction.
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PMID:Use of nephrostomy tubes in ureteric obstruction from incurable malignancy. 1272 19

Pelvic surgery is the most common cause of iatrogenic ureteral injury. The majority of patients with ureteral injuries have no identifiable predisposing risk factors. A simple maneuver that has been taught successfully at our institution that facilitates the identification of the ureter is described. When injury is discovered during surgery, correction of the injury can be repaired with minimal risk of long-term sequelae. Postoperatively, patients with ureteral injury typically present with costovertebral angle tenderness, ileus, fever, and flank pain with a minimal rise in serum creatinine. To prevent ureteral injuries, the surgeon must have a thorough knowledge of the location of the ureter during various pelvic procedures and the specific regions where it is most susceptible to injury.
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PMID:Prevention of ureteral injuries in gynecologic surgery. 1274 97

Acute renal failure (ARF) occasionally occurs after intravenous injection of contrast medium, but complications are rare after retrograde pyelography. After reviewing the reports in the English-language literature, the authors found very few on those complications after retrograde pyelography. The authors present a patient who had ARF after the technique. The patient had a history of hypopharyngeal cancer with underlying serum creatinine level at the high end of the normal limits. Bilateral flank pain and decreased urine amount were noted soon after the procedure of retrograde pyelography. Subsequently, blood urea nitrogen and creatinine levels both elevated, and hemodialysis was needed. Several days later, diuretic phase took place. Thereafter, the symptoms subsided gradually. Pyelorenal extravasation of contrast medium was remarkable during the procedure. There was no evidence of hydronephrosis during the course of ARF. Early awareness and management may prevent the complications of ARF such as acute lung edema and hyperkalemia. Therefore, clinical physicians should be aware of the occurrence of ARF and its clinical presentation after performing retrograde pyelography.
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PMID:ARF after retrograde pyelography: a case report and literature review. 1290 Aug 46

BACKGROUND: To determine accuracy of ultrasound (US) kidney, ureter and bladder (KUB) compared to un-enhanced helical CT (UHCT) in patients with renal failure in the diagnosis of stone and obstruction. METHODS: This is a case controlled study conducted in the period from June 2000 to July 2003 at a university hospital. All patients had both US and UHCT scan. Patients with serum creatinine >/= 1.8 mg/dl were included in the study. Only direct visualization of stone was considered as confirmatory. In both the studies, UHCT and US, presence of stone and obstruction were noted. The relevant biochemicals, radiological and clinical records of all the patients were analyzed. Data was analyzed using commercially available software. RESULTS: During the period of study 864 patients had UHCT for evaluation of the urinary tract in patients presenting with flank pain. Out of these 34 patients had both UHCT and US done within a span of one day and had serum creatinine of >/=1.8 mg/dl. Mean age was 48 +/-15.8 years and 59% of patients were males. UHCT identified renal stones in 21 (62%), whereas 17 of these were identified on US, with a sensitivity of 81%. Of the four patients with renal stones missed on US, three were identified on plain x-ray; the mean size of stones missed was 6.3 mm. Of the 22 (65%) patients with ureteric stone on UHCT, US could only identify 10; a further 7 were identified on x-ray KUB, giving a sensitivity of 45% (US alone) and 77% (US with x-ray KUB). CONCLUSIONS: US is sensitive and specific for renal stones, 81% and 100% and for hydronephrosis, 93% and 100%, respectively. Its sensitivity to pick ureteric stone (46%) and to identify hydroureter (50%) is low. Addition of x-ray KUB abdomen increases the sensitivity for ureteric stones to 77%.
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PMID:Diagnostic accuracy of ultrasonography compared to unenhanced CT for stone and obstruction in patients with renal failure. 1528 70

Seven patients aged 13 to 17.5 years developed acute renal failure after treatment with a variety of non-steroidal anti-inflammatory drugs (NSAID): naproxen, diclofenac, ibuprofen, dipyrone and paracetamol. Six of the patients used more than one kind of NSAID. None of the patients had previous history of renal disease or concomitant treatment with other drugs. The time interval between NSAID administration to the emergence of symptoms ranged from 1 to 4 days. The most common presenting symptoms were flank pain (4 patients), abdominal pain (3 patients) and vomiting (3 patients). All patients had normal urine output. Microscopic hematuria and proteinuria were found in 5 patients and leukocyturia in 2. Serum creatinine ranged from 1.3 to 8.3 mg% at presentation. Kidney biopsy was performed in 3 patients and showed findings consistent with mild interstitial inflammation in 1 patient, and normal renal tissue in 2. All patients were treated with intravenous fluids, 1 received corticosteroids. Renal function completely normalized in all patients within 7 to 16 days.
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PMID:Acute renal failure, associated with non-steroidal anti-inflammatory drugs in healthy children. 1597 24

The successful endovascular repair of a type III thoracoabdominal aortic aneurysm (TAAA) with the use of a tube endograft is reported. A 56-year-old male with a 6.4-cm type III TAAA, a 4.2-cm infrarenal abdominal aortic aneurysm, and chronic renal insufficiency presented with flank pain, nausea, acute anuria, and serum creatinine of 6.1 mg/dl. Acute occlusion of the left solitary renal artery was diagnosed and emergent recanalization with percutaneous transluminal angioplasty and stenting was performed successfully, with reversal of the serum creatinine level at 1.6 mg/dl. Further imaging studies for TAAA management revealed ostial occlusion of both the celiac artery (CA) and the superior mesenteric artery (SMA) but a hypertrophic inferior mesenteric artery (IMA) providing retrograde flow to the aforementioned vessels. This rare anatomic serendipity allowed us to repair the TAAA simply by using a two-component tube endograft without fenestrations (Zenith; William Cook, Bjaeverskov, Denmark) that covered the entire length of the aneurysm, including the CA and SMA origins, since a natural arterial bypass from the IMA to the CA and SMA already existed, affording protection from gastrointestinal ischemic complications. The patient had a fast and uneventful recovery and is currently doing well 6 months after the procedure. To our knowledge, this is the first report in the English literature of successful endovascular repair of a TAAA involving visceral arteries with the simple use of a tube endograft.
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PMID:Endovascular repair of a type III thoracoabdominal aortic aneurysm in a patient with occlusion of visceral arteries. 1745 Mar 97

We report two cases of acute renal failure in patients with nonfulminant acute hepatitis A. First case is a healthy 25 year-old man complained of myalgia and jaundice. Initial laboratory results showed BUN 40 mg/dL, creatinine 5.23 mg/dL, AST 2,220 IU/L, ALT 3,530 IU/L, total bilirubin 6.26 mg/dL, and positive anti-HAV IgM antibody. Supportive treatments including fluid therapy were started. Serum creatinine and total bilirubin levels were 7.98 mg/dL and 7.66 mg/dL respectively on the 5th hospital day, and decreased gradually. He was discharged on the 12th hospital day, and was being followed up in outpatient department. Second case is a 33 year-old woman who admitted for bilateral flank pain, high fever, nausea, and vomiting. She was diagnosed as acute pyelonephritis and acute hepatitis A. On admission, BUN 13 mg/dL, creatinine 0.74 mg/dL, AST 3,720 IU/L, ALT 2,280 IU/L, total bilirubin 0.9 mg/dL were noted, and acute renal failure developed next day. Fluid therapy with antibiotics administration were started, and maximal BUN and creatinine was 41.7 and 8.09 mg/dL respectively on the 8th day. She recovered without dialysis and was discharged on the 19th hospital day. Proper and prompt comprehensive supportive measures would decrease the need for dialysis in patient of acute renal failue associated with acute hepatitis A.
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PMID:[Two cases of acute renal failure associated with nonfulminant acute hepatitis A]. 1792 55

Emphysematous pyelonephritis (EPN) is a serious and often life-threatening condition due to a gas-producing and necrotizing infection involving the renal parenchyma and perirenal tissue. The infection is almost exclusively seen in diabetic patients, and the main feature of its presence is finding gas within the kidney. Patients usually present with fever, chills, flank pain, and dysuria. Laboratory testing usually reveals hyperglycemia, leukocytosis, pyuria, an elevated blood urea nitrogen (BUN) level, and high serum creatinine level. Other, nonspecific symptoms such as abdominal pain, nausea, vomiting, and diarrhea can accompany acute pyelonephritis, as found in the reported case. The appropriate management of such serious infection requires combined medical and surgical treatment. In severe infection, nephrectomy should not be delayed. We report a case of EPN in a diabetic patient who presented with gastrointestinal symptoms. A high index of suspicion, coupled with a good imaging study [preferably computed tomography (CT) scanning] of the abdomen can lead to early diagnosis. Appropriate medical and surgical management have resulted in a successful outcome.
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PMID:Emphysematous pyelonephritis presenting as gastroenteritis. 1809 Aug 85

A 56-year-old woman with obesity and poorly controlled diabetes mellitus presented with a two-day history of abdominal fullness and vomiting. No fever, flank pain or dysuria was present. On admission, her blood urea nitrogen concentration was 74 mg per deciliter and the serum creatinine concentration was 3.5 mg per deciliter. Laboratory data revealed an elevated white blood cell count (11.72 x 10(3)/ml), blood sugar (826 mg/dl), pyuria (WBC 30-50/HPF) and negative urine ketone. A plain abdominal radiograph revealed right renal stones and localized air accumulation at the left upper abdominal area.
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PMID:Emphysematous pyelonephritis with acute renal failure. 1861 55


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