My father was taken to the ER on Sunday night complaining with back pain that started earlier in the day and progressively got worse. He was first diagnosed with kidney stones. They hooked him up to a morphine pump and kept him extremely lethargic for the rest of Sunday night and Monday. Monday evening the doctor says he doesn’t think it’s kidney stones and they need to do more test. The back pain has now moved down to the groin area. The tests revealed nothing. No blood in urine, no stones, nothing. They have no clue! The doctors answer to the everything seemed to be “increase the pain med”. Wednesday morning he tells my father he’s going to send him to physical therapy. Why, is the next question my father asks and is given a left field answer. My father whose blood pressure has been fairly high throughout his stay (top number in the 200’s) is exhausted and tired of the pain and just really wants some answers, requests to be transferred to another hospital. He was transferred today where their tests revealed no stones but DID show blood in the urine. Can you please give me a few explanations of why this is happening. This started as pain in the lower right side of his back, a few times he did experience pain during urination(he thought he was trying to pass the stone) and now the pain is in the groin area. He’s had no other signs or symptoms. He just woke up one morning with this pain. He is 53 y/o and in good health. He’s had a sinus infection for a week or so and experienced slightly elevated blood pressure in the last month which our family physician associated with needing to lose about 20 lbs. He’s VERY active and I’m pulling my hair out trying to get to the bottom of this. PLEASE HELP!!!

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Dr. Joshua’s Answer:

The first thing that comes to mind is indeed urinary stones. It’s not clear to me exactly which investigations were done, and how they ruled out urinary tract stones. Blood was later detected, but it’s hard to say for me whether this was caused by stones or some examinations or interventions that were performed in the first hospital. Back pain can be caused by many things - it seems like the local doctors first suspected urinary stones, but it puzzles me that they subsequently wanted to send him to physical therapy - suggesting that they concluded the pain must be of musculoskeletal (back muscles) origin. I’m sure the usual labwork and radiology was done. Was abdominal and kidney ultrasound done? A clinical examination is crucial, as usual, and I don’t know what the clinical signs were. Sudden back pain like this can indeed be caused by urinary stones (treatment: NSAID pain medication, rehydration i.e. drinking a lot of water, proper diet, and there’s also a host of surgical treatment options). The high blood pressure may have been because of the pain. At worst, these symptoms might be a sign of renal artery occlusion, meaning blockage of blood flow to the kidney, resulting in kidney ischemia (lack of blood and therefore lack of oxygen). This may cause back/flank pain and persisting hypertension. Lab tests and urinalysis would not reveal the diagnosis. Kidney angiogram (imaging of the blood vessels) would rule this out. In the case of renal artery occlusion, a cardiology consult would be in order to determine the cause, because the source of such occlusion is usually the heart. Since your father has been treated in two hospitals already, I’m sure this possibility has been covered.?

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