[22F] With persistent kidney pain and urinary issues post-infection

Patient Description

A 22-year-old female has been experiencing constant aching pain in the right kidney area for the past 8 months, following a severe kidney infection. The pain is described as a constant ache with random shooting pain up and down the back, exacerbated by movement or changes in position, and ranges from 3 to 10 in severity. Despite using fentanyl for pain relief, the pain remains persistent. The patient also reports fatigue, rarely urinating (about once a day), painful urination with a burning sensation, and low urine output for the past 4 months. No bacteria or blood has been found in the urine. Additional symptoms include a low-grade fever that comes and goes, constant nausea with occasional vomiting, weakness, fatigue, and restlessness. The patient has trouble sleeping due to the pain, which has been ongoing for 6 months, and experiences depression and anxiety due to frequent emergency room visits without conclusive results. No pre-existing conditions or chronic illnesses are reported, and the patient is not taking any prescribed medications.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Chronic Kidney Disease (CKD): This condition can develop after a severe kidney infection and can cause persistent pain, reduced urine output, and fatigue. CKD can also lead to protein in the urine and other symptoms like nausea and weakness.

    • Treatment: Management typically involves medications to control symptoms, dietary changes, and regular monitoring by a healthcare provider. In severe cases, dialysis or a kidney transplant may be necessary.
  • Interstitial Nephritis: This is an inflammation of the kidney's tubules and surrounding structures, which can be caused by infections, medications, or autoimmune diseases. Symptoms include pain, reduced urine output, and protein in the urine.

    • Treatment: Treatment often involves addressing the underlying cause, such as stopping a causative medication or treating an infection. Corticosteroids may be prescribed to reduce inflammation.
  • Kidney Stones: While you did not mention passing stones, kidney stones can cause severe pain that radiates to the back and groin, along with nausea and vomiting.

    • Treatment: Smaller stones may pass on their own with increased fluid intake and pain management. Larger stones may require medical procedures to break them up or remove them.
  • Persistent Urinary Tract Infection (UTI): Although no bacteria were found in your urine, some infections can be difficult to detect or may have caused lasting damage leading to chronic symptoms.

    • Treatment: Antibiotics are typically used to treat UTIs. Persistent symptoms may require further investigation to rule out other conditions.

What you can do

  1. Consult a Healthcare Provider: Given the severity and duration of your symptoms, it is crucial to consult a healthcare provider for a thorough evaluation and appropriate testing. This may include blood tests, urine tests, imaging studies, and possibly a referral to a nephrologist (kidney specialist).

  2. Stay Hydrated: Drink plenty of water to help your kidneys function properly and to flush out any potential irritants.

  3. Pain Management: While fentanyl is a strong pain medication, it is important to use it under medical supervision due to its potential for addiction and other side effects. Discuss alternative pain management options with your healthcare provider.

  4. Monitor Symptoms: Keep a detailed record of your symptoms, including pain levels, urine output, and any other changes. This information can be valuable for your healthcare provider.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Severe Pain: If your pain becomes unbearable or significantly worsens.
  • High Fever: A persistent high fever could indicate an ongoing infection.
  • Blood in Urine: This could be a sign of a more serious condition.
  • Severe Nausea or Vomiting: If you cannot keep fluids down, you may become dehydrated.
  • Swelling: Swelling in your legs, ankles, or around your eyes could indicate worsening kidney function.

Remember, while this information can provide some guidance, it is essential to seek care from real health professionals to receive a formal diagnosis and appropriate treatment.

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6 mo ago


People Also Ask


What are the common symptoms of chronic kidney disease (CKD)?

Common symptoms of chronic kidney disease include fatigue, reduced urine output, swelling in the legs and ankles, persistent nausea, and changes in urination patterns. It can also cause high blood pressure and protein in the urine.


How can interstitial nephritis be diagnosed and treated?

Interstitial nephritis can be diagnosed through blood tests, urine tests, and imaging studies like an ultrasound or CT scan. Treatment typically involves addressing the underlying cause, such as stopping a causative medication or treating an infection, and may include corticosteroids to reduce inflammation.


What are the signs that a kidney stone might be causing my symptoms?

Signs that a kidney stone might be causing symptoms include severe pain in the back or side, pain that radiates to the lower abdomen and groin, nausea, vomiting, and blood in the urine. Imaging tests like an ultrasound or CT scan can help confirm the presence of stones.


Why might a urinary tract infection (UTI) not show bacteria in urine tests?

A urinary tract infection might not show bacteria in urine tests if the infection is caused by atypical bacteria or if the infection is located in a part of the urinary tract that is not easily detected by standard tests. In some cases, symptoms may persist due to inflammation or damage from a previous infection.

1 Comments


Leo#3962

6 mo ago

Do you have any information about your kidney function from you emergency room visits? The big ones would be creatinine (abbreviated Cr), BUN, and GFR or eGFR.

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