Renal System Causes of Low Back Pain


Risk Factors of Renal and Urinary Tract Problem

  • Age over 60
  • Personal or family history of diabetes or hypertension
  • Personal or family history of kidney disease, heart attack, or stroke
  • Personal or family history of kidney stones, urinary tract infections, lower urinary tract obstruction, or autoimmune disease.
  • African, Hispanic, Pacific Islander, or Native American decent
  • Exposure to chemicals (i.e. paint, glue, degreasing solvents, chemical solvents), drugs or environmental conditions
  • Low birth weight 

Murphy's Percussion - Clinical Test to Rule in/out Renal Involvement

 
  The Murphy's Percussion in one of the many tests performed to describe physical findings relating to the abdomen. This assessment is specifically utilzed to rule out kidney involvment or pusedorenal pain.  In performing the percussion test the patient can be either in a porne or sitting position. The examiner places on hand over the costovertebral angle of the patients back.  Next the examiner provides a precussive thump with their other hand onto the costovertebral angle allowing the kidney to vibrate.  A postive test is noted by either costovertebral tenderness or reproduction of back/flank pain signaling a red flag for renal involvement.   If a patient experenices no pain after the thud is perfromed then renal involvement is ruled out. 

Acute Pyelonephritis

       
    Acute Pyelonephritis is an infection of the upper urinary tract involving the kidneys in which bacteria ascend from the bladder to infect the kidney.  The main bacteria causing this condition is E. Coli, other gram negative bacteria that cause this condition include Proteus, Klebsiella, Enterbacter, and Pseudomonas.  Over 250,000 people per year are diagnosed with acute pyelonephritis resulting in 200,000 hospital admission annually.  The vast majority of cases occur in women, but men have a higher complication rate.  Patients with severe acute pyelonephritis are usually hospitalized and treated within 5 days of symptom onset.  A through subjective examination regarding the presence of any constitutional symptoms or changes in bowel and bladder is imperative.  Therefore, patients with any pattern of signs and symptoms or risk factors should be referred to their primary care physician for further testing.


Risk Factors

  • Frequent sexual activity
  • Recent Urinary Tract Infection
  • Recent spermicide use
  • Diabetes 
  • Recent Incontinence


Signs and Symptoms

  • Fever
  • Chills
  • Malaise
  • Headache
  • Confusion
  • Flank or Lower back pain
  • Tenderness of costovertebral angle (Positive Murphy's Percussion)
  • Bladder irritation may be present including: dysuria, urinary frequency, and urgency


Perinephric Abscess

   
   A Perinephric Abscess is a localized collection of purulent material between the kidney capsule and the surrounding fascia.  It is a result of an untreated urinary tract infection, intranephric renal abscess, recurrent pyelonephritis, obstruction, or hematogenous spread. The main organisms of this condition are E. coli, Proteus, and Staphylococcus aureus.  Onset of symptoms are insidious, and a majority of patients report pain for greater than 14 days.  Symptoms that present are indicative of acute pyelonephritis which include fever, dsyuria, and flank/low back pain.  In rare cases, a palpable flank mass or rash may be present (Table 1).  A useful clinical feature of perinephric abscess is that patients are symptomatic for greater than a week; in contrast to patients with acute pyelonephritis which are frequently hospitalized within 5 days of symptom onset.  This presentation may delay the diagnosis and treatment of perinephric abscess  due to its insidious nature.


Risk Factors

  • Diabetes Mellitus
  • Urinary Tract Calculi
  • Urinary Tract Obstruction
  • Recent or recurrent Urinary Tract Infection
  • Recurrent Acute Pyelonephritis 


Signs and Symptoms

  • Dysuria
  • Fever
  • Flank/Low Back Pain
  • Tenderness of costovertebral angle (Positive Murphy's Percussion)


Nephrolithiasis - Kidney Stones


    Nephrolithiasis is the third most common urinary tract disorder seen within our population.  The size of the stone can range from a popcorn kernel to a jagged "Starburst" (Table 2).  Crystals grow at a rate depending on the saturation of urine.  Males between the ages of 30 - 60 have an increased incidence of kidney stones, whereas females between the ages of 20 - 30 are more at risk.  Areas that are high in temperature and humidity have been noted to also have an increase incidence of kidney stones.  The hallmark symptoms noted by patients include flank pain radiating to the groin and low back pain, blood in the urine, nausea, and vomiting.  Patients will also state having a "colicky" type of pain which noted by an abrupt start and stop of pain.  A through subjective examination regarding the presence of any constitutional symptoms or changes in bowel and bladder is imperative.  Therefore, patients with any pattern of signs and symptoms or risk factors should be referred to their primary care physician for further testing.
   

Risk Factors

  • Males between the age of 30 -60
  • Females between the age of 20 - 30
  • Areas with increase temperature and humidity
  • High intake of animal proteins, sodium, refined sugar, oxalate, grapefruit juice, apple juice, and soda
  • Low fluid intake
  • Personal or family history of kidney stones

Signs and Symptoms

  • Colicky pain
  • Pain Radiating from flank to low back or groin
  • Hematuria
  • Unable to find comfortable position
  • Nausea
  • Vomiting
  • Dysuria