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Monday, December 9, 2013
My case is rather complex as I have elevated CRP along with elevated C3. Those 2 particular tests have been elevated for 2 years and continue to increase. However, in March of this year I began having R Flank pain...dull, sharp sometimes. I also have tenderness with movement and with deep palpation. I have also been having RUQ abdominal pain and went to the GI doctor. He ordered an abdominal US, where it was incidentally found that both my Kidneys are enlarged with "heterogeneous tissue changes." No stones, hydronephrosis, etc. were visualized. My questions: What causes kidney enlargement AND pain with and without movement, palpation? Does Lupus Nephritis typically present in this manner? I had a urinalysis with urine culture that was negative. Family hx: Father had CRF; Aunt had bladder CA; Uncle had a nephrectomy due to Glomerulernephritis, remaining kidney currently failing on transplant list...Thank you
I don't have enough info to give you very specific answers to your questions. It would help to know your age, gender, and ethnic origin. It is also not clear exactly what the radiologist means by "heterogeneous tissue changes," and the only way to tell would be to either look at the films or to speak directly with the radiologist who read them. Could the radiologist have said "echogenic tissue"? (If so, this would mean either that there is scar tissue in the kidneys, or that some sort of substance that shouldn't be there is infiltrating the kidneys.)
Anyway, here are some thoughts: Usually enlarged kidneys are not painful, but sometimes if they are swollen because of inflammation (as your high CRP might suggest) or because of rapid growth and stretching (as by a malignancy) they may hurt. However, bear in mind that your right flank pain may or may not be related to the kidney enlargement. For instance, there are numerous muscles in the back and flank area, and these may be the cause of the pain.
The most common cause of enlarged kidneys is diabetes. Other causes of enlarged kidneys, especially associated with "heterogeneous tissue changes," are:
- HIV infection
- Malignancy (especially lymphoma or leukemia: unlikely in your case to have gone undiagnosed for two years)
- Some types of glomerulonephritis (inflammatory disease of the kidney)
This would not be the typical presentation of lupus nephritis, but if this diagnosis is suspected, your doctor should order (if they haven't done so already) blood tests for lupus and related (so-called "autoimmune" or "collagen-vascular") diseases. These tests include ANA, ANCA, ESR, ENA, SPEP, and UPEP. It is hard to believe that your urinalysis is completely normal; has your kidney function also been tested (with blood tests: BUN and serum creatinine)? Is there any protein or blood in your urine?
Depending on what your other symptoms and lab tests show, it might be very useful for your doctor to refer you to a nephrologist (kidney specialist) to be evaluated for a kidney biopsy. If you do see a nephrologist, I would try to find out as much specific information as you can about the cause of your father's and your uncle's kidney diseases and bring that information with you. There are many types of chronic renal failure and of glomerulonephritis; some run in families, but most do not; if your dad/uncle has one of the hereditary types (and particularly if your dad and your uncle are brothers), this info could be invaluable in making your diagnosis. Good luck!
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University