Back pain is one of the most common reasons for being absent from work. It is, in fact, ranked as the second most common chief complaint upon consultationto the physician, only surpassed by respiratory tract symptoms. 
Yes, this fact is quite alarming. And yes, back pain can be a symptom of a kidney problem. However, not all back pains are caused by kidney diseases. Thus, how would one know if his back pain is indeed rooted from a pathology in the kidneys?
Kidneys: An Anatomic Overview
Kidneys are bean shaped organs approximately 11 to 14 centimeters long, 6 centimeters wide and 4 centimeters thick. Located in the abdominal cavity, they lie retroperitoneally. The right kidney is placed lower than the left, with the latter being slightly more medial than the former. The left kidney is at the level of T12 to L3, and its counterpart slightly lower.
The image shows the location of both kidneys: the left at the T12 to L3 level and the right lower than the other.
Kidney Pain: Where It Should Be Felt
Since it is situated behind the peritoneum, kidney pain is felt not exactly on the contained area. It is usually felt in the flanks, between the hip and the lower ribs, lateral to the spine[3,4].
Area of kidney pain: in the flanks, between the hip and lower ribs, and lateral to the spine.
Kidneys and Physical Assessment: How to Elicit Kidney Pain
In doing a complete physical examination, one should never forget to examine the kidneys. This should include both percussion and palpation.
A diagnostic method first done by John Benjamin Murphy, this test is easy to do, but can elicit severe pain . It evaluates the degree of tenderness.
This procedure is done with the patient sitting and the physician standing behind him. The area over the costovertebral angle is striked at with the fisted dominant hand, with or without the palm of the nondominant hand placed over the angle. 
An image showing the correct method on how to do kidney percussion.
With the physician standing at the right side of the patient, the test is done with the subject lying supine. Each kidney is checked one at a time. Assuming the right kidney is to be examined first, the left hand should be placed in the flank area and the right hand above it. The hands are then pushed together while the patient takes a deep breath. The kidney may then be felt descending. If an enlarged kidney is present, it can gently bounce between the hands upon examination. 
The photo depicts how to perform an accurate kidney palpation.
Kidney Symptoms: What Else Should We Look For?
Once confirmed thru physical examination that it is indeed kidney pain, one needs to be aware of the other clinical manifestations of kidney pathologies. These warning signs and symptoms include:
- High blood pressure levels
- Persistent fatigue
- Changes in the amount and frequency of urination
- Dark colored or blood tinged urine
- Muscle cramps
- Pain and difficulty urinating
- Swollen face and/or extremities
- Inability to concentrate
- Unpleasant taste in the mouth
- Nausea and vomiting
- Joint pain
- Nail abnormalities
- Bad smelling urine
- Visible swelling and inflammation of the area
These manifestations may increase in severity as the kidney problem worsens. Hence, prompt diagnosis is of extreme importance. [8, 9, 10, 11]
What Could Have Caused This Pain?
There are numerous possibilities when one queries on what can cause kidney pains.
Urinary Tract Infection
Consisting of the kidneys, bladder, ureters and urethra, infection of the urinary tract can brought about kidney pain. Aside from pain, vomiting, nausea, chills, fever, abdominal pain, frequent urination and decreasing amount of urine can also ensue. [3,11]
Usually arising from the urinary tract, infections can ascend to the kidneys causing pyelonephritis. Renal tissues get inflamed, causing pain. This pain can be characterized as dull and one sided, located at the upper back, and associated with fever and other urinary manifestations. If not treated, this may lead to severe permanent renal damage. [3,11, 12]
These stones are usually calcium deposits lodged in the ureters, blocking the flow of urine and causing excessive pain. The said pain is characterized as colicky, with episodes of sharp and stabbing pain localized at the flanks. These stones may be brought about by fluid and electrolyte imbalances. They may be associated with the presence of blood tinged urine. Removal of such stones is recommended to prevent further renal injury. [3,4,11,13]
Leading to enlargement of kidneys and subsequent pain, polycystic kidney diseases usually begins as a hereditary condition in which numerous renal cysts are present. At times, the said pain is dull and aching, and is noted at the abdomen rather than the flank. If left untreated, this can eventually lead to renal failure. [3, 11, 13]
Literally meaning “water within the kidney”, hydronephrosis pertains to distention of the renal organs due to urinary obstruction . This occurs as a sudden intense pain at the flanks, and is associated with nausea, vomiting and fever . If untreated, this may lead to complete obstruction and subsequent renal failure .
Accumulation of fats in the renal artery walls lead to arteriosclerosis. Circulation is subsequently blocked and the arteries harden, further preventing blood to be supplied to the kidney. Hence, causing severe pain. [3, 11]
Although rare, renal cancers may manifest as growths on the urinary tract. These consequently cause the renal capsules to stretch, putting pressure on the nerves, and bring severe flank pain. This is also associated with hematuria and may even cause blood loss. [3, 11, 13]
What To Do Next?
In order to address the kidney pain, a correct diagnosis is of utmost importance. A complete history and physical examination should initially be done. Based from these, a number of tests may be done for confirmation of the diagnosis. [3,13]
- Urinalysis – to detect the major etiology
- Complete Blood Count –to determine the presence of infection and anemia
- Blood and Urine Cultures - also done to identify the causative agent
- Intravenous Pyelogram, abdominal or KUB films – detect the structures and sizes of the kidneys and ureters, and to determine the presence of urinary stones
- CT, MRI and ultrasound – for confirmation of diagnosis
Treating Kidney Pain and Its Sources
Once the diagnosis is confirmed, immediate treatment of the kidney disease is recommended to avoid further renal injury. Antibiotics are required to treat urinary tract and kidney infections. Renal carcinoma may need surgery, immunotherapy and radiotherapy for remission. Kidney stones may require medications to pass out the lithiases. Polycystic kidney disease may need medications to relieve pain and lower blood pressure, and surgery to drain the cysts.[13, 17]
However, it does not end there. The best management of these kidney pains is still prevention. This can be done thru a number of ways: [11, 13, 18, 19]
- Increase oral fluid intake – around two to three liters per day for renal stone formers
- Encourage consumption of vegetables and fruits
- Have a low salt diet
- Exercise – do at least 30 to 60 minutes of exercise
- Maintain ideal weight – may use body mass index
Just a friendly reminder, always consult your physician when experiencing such pain before taking any medications. Intake of a pain reliever, may ease your kidney pain at that moment, but may worsen the renal injury… bringing more severe pain heading your way!
1. Vallfors, B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scandinavian Journal of Rehabilitation Medicine Supplement. 1985; 11:1-98.
2. Walter, F. (2004) Medical Physiology: A Cellular and Molecular Approach. Elsevier/Saunders.
5. Houppermans, R. et al. Physical Diagnosis—Pain Elicited By Percussion in the Kidney Area (translated). Ned TijdschrGeneeskd. 2001 Feb; 145(5): 208-10.
7. http://www.physical examination.org
14. Kumar, et al.(2005). Robbins and Cotran Pathologic Basis of Disease (7thed). Philadelphia PA: Elsevier Saunders. pp 1012-4.
15. Mergener, K. Dietl Crisis: A Syndrome of Episodic Abdominal Pain of Urologic Origin That May Present To a Gastroenterologist. American Journal of Gastroenterology. 1997 Dec; 92 (12): 2289-91.
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