Where do you feel kidney pain?
Looking from the outside, the kidneys are located on the sides of the middle-lower back, under and partly below the lower ribs (Picture 1). Looking from the inside, kidneys lie deep in the upper abdomen, underneath the diaphragm on the either side of the spine (in the so-called retroperitoneal space, which means behind the peritoneal membrane).
Picture 1. Kidney pain appears where the kidneys are located
(the view from the back).
Where does kidney pain hurt:
- In one or both flanks (loin pain) — in the area between the lower ribs and hips
- Deeply in the upper abdomen on the left, right or both sides
- Pain from the kidney stones that lodge in the ureter can radiate from the flanks toward the genitalia, groin and inner thighs.
What does kidney pain feel like?
Description of the kidney pain:
- Sudden (acute) or persistent (chronic)
- Mild or severe
- Sharp, dull, throbbing or, rarely, cramping or colicky
- One sided or both-sided.
Kidney pain is often, but not always, associated with tenderness in the kidney area.
Symptoms and Signs
Pain that originates in the kidneys is not very characteristic and can be easily confused with the pain arising from other abdominal organs (spleen, pancreas) abdominal aorta (aneurysm), lungs, back muscles, spine or spinal nerves. They are additional symptoms, which can speak for the kidney origin of the pain (1,3,4,7):
- Nausea, vomiting, anorexia, fever, chills
- Increased frequency of urination, blood in the urine
- A lump in the flanks or upper abdomen
- Body swelling (edema)
The sign that lower back pain arises from the kidneys: flanks may be tender to the touch, a doctor can provoke pain by tapping over the kidneys or by a slight punch to the kidney area.
Is kidney failure painful?
Neither acute or chronic kidney failure by itself is usually painful. Kidney failure means severe impairment of the kidney function, but the kidney as an organ is usually not damaged in the early phase of kidney failure. It is the cause of kidney failure, such as severe kidney infection or inflammation, that can cause pain, though. Symptoms of kidney failure are quite nonspecific and may include increased or decreased urination, fatigue, nausea, unintentional weight loss, pale and itchy skin, swollen ankles and hands, shortness of breath (16). Severe acute kidney failure may cause pain in the flank(s) (29).
Sudden (Acute), Severe Kidney Pain or Renal Colic
Kidney Stone Pain
Kidney stones (renal calculi) usually cause symptoms only when they lodge in the ureter and obstruct the urine flow. Symptoms often start at night or in the early morning and may include (2,4):
- Sudden, sharp, severe, even extreme excruciating pain, in the right or left flank, which develops within 30 minutes to few hours to full intensity and can remain constant for up to 18 hours and then wears off in few hours; pain can radiate down to the lower abdomen, testicles or vulva (Picture 2). Urinary stone pain sometimes presents as an intermittent colic (spasm).
- Blood and, eventually, one or more stones in the urine
- Nausea, vomiting
- No fever (except when infection occurs)
Picture 2. Kidney stone pain
The pain from the kidney stones can be felt in the flank,
lower abdomen and genitalia
- Obstruction of the ureteropelvic junction (UPJ) or pelvi-ureteric junction (PUJ), which most commonly occurs in children, is the obstruction of the upper part of the ureter due to congenital disorders, surgery or infection (2). Main characteristics are a palpable mass in the upper abdomen due to dilated kidney (hydronephrosis), occasional flank pain, especially after drinking large amount of fluid, like alcohol (25) or caffeinated drinks, or after diuretics (26), and blood in the urine (2).
- Acute hydronephrosis (swelling of the kidney due to filling with urine), mostly due to a stone in the ureter (7)
- Blood clots in the ureter due to kidney injury or investigation, kidney tumors, sickle cell anemia, hemophilia (2)
- Acute renal infarction due to embolism of renal artery or its branches in individuals older than 50 years: main symptoms are sudden flank pain on one side and blood in the urine (2)
- Renal vein thrombosis (19)
- Renal papillary necrosis due to diabetes, liver cirrhosis or analgesic abuse, mainly in women (2)
- Loin pain hematuria syndrome (LPHS) in women who take oral contraceptives (23).
Throbbing Kidney Pain
Throbbing, pulsating pain in the kidney area, which can radiate up or down the back and may last for several seconds to minutes, can be caused by:
- Blockage of the urine flow due to ureteropelvic junction (UPJ) obstruction, stricture after surgery or ureteral stone (17)
- IgA nephropathy or Berger’s disease (a type of kidney inflammation — glomerulonephritis): brown, cola- or tea-colored urine and spasms in the flanks within 72 hours after the onset of respiratory infection or gastroenteritis (10,18)
- Renal vein thrombosis (21)
- Cystinuria (11)
- Loin pain hematuria syndrome (LPHS): persistent or recurrent burning or throbbing loin pain on one or both sides, which may be triggered by movement or exercise; blood in the urine (not always), sometimes fever or nausea. Symptom episodes may last from hours to months (12).
Dull Kidney Pain
Kidney Infection (Pyelonephritis) Pain and Associated Symptoms
Symptoms of urinary tract infection (UTI) that involves kidneys (pyelonephritis) develop in few hours or days and may include (1,2,3):
- Mild, dull ache, discomfort and tenderness in the left, right or both flanks
- Nausea, vomiting
- High fever and chills (not always)
- Occasional symptoms: loss of appetite, diarrhea, stiff neck
- Symptoms of the associated bladder infection (cystitis) or infection of the urethra (urethritis): cloudy and foul smelling urine, blood in the urine, frequent urination, urge to urinate, burning pain during urination.
Kidney infections are much more common in women than in men.
- Renal abscess is a localized collection of pus within a kidney — it usually occurs as a complication of infection. A doctor may detect a palpable mass in the loin (2).
- Fungal bezoars may occur after kidney transplantation or in diabetes or during long-term antibiotic treatment (2,8)
- IgA nephropathy or Berger’s disease (a type of kidney inflammation or glomerulonephritis): brown, cola-colored or red urine and dull flank pain within 48 hours after onset of a respiratory or gastrointestinal infection; symptoms may last for up to 3 days (10,18).
- Polycystic kidney disease (13)
- Chronic hydronephrosis due to gradual blockage of the urinary tract, for example, due to ureteral stricture after ureteroscopy, kidney stone, radiation or kidney surgery (5,7)
- Kidney cyst, tumor or cancer: gradual development of flank pain, blood in the urine (9)
- Narrowing of the kidney artery–renal artery stenosis–due to atherosclerosis with clot formation or ischemia, steady ache in the flank, blood in the urine, high blood pressure (20)
- Nutcracker syndrome (compression of the left renal vein): left flank pain, blood in the urine (22)
- Idiopathic loin pain haematuria syndrome (LPHS) (12)
- Retroperitoneal fibrosis — development of scar tissue in the area around the kidneys, mostly from an unknown cause (2).
Bilateral Kidney Pain (in Both Flanks)
Disorders that can cause kidney pain on both sides at the same time:
- Kidney infection (pyelonephritis) (6)
- Kidney inflammation:
- Glomerulonephritis, such as IgA nephropathy(6), post-streptococcal glomerulonephritis after strep throat (sore throat followed by flank pain, malaise, blood in urine) (28)
- Polycystic kidney disease; flank pain, blood in the urine, recurring urinary tract infections (13)
- Nephrocalcinosis: symptoms are caused by kidney stones (14)
- Bilateral hydronephrosis (15)
- Loin pain hematuria syndrome (LPHS) (12)
- Renal vasculitis: polyarteritis nodosa, Henoch-Schönlein purpura, essential mixed cryoglobulinemia, microscopic polyangiitis, Wegener’s granulomatosis (6,27)
- Retroperitoneal fibrosis (6)
- Other causes (6): X-ray contrast toxicity, ethylene glycol poisoning (ingestion), arsine gas poisoning, Haff disease after eating Buffalo fish, blood hemolysis, such as in sickle cell anemia, myoglobinuria after muscle breakdown (rhabdomyolysis), paroxysmal cold hemoglobinuria, anaphylactic reaction, transfusion reaction, serum sickness.
- NHS (UK) (kidney infection)
- Emedicine (reasons for flank pain)
- Emedicine (pyelonephritis)
- Emedicine (renal colic due to kidney stones)
- Emedicine (ureteral strictures)
- Diagnosispro.com (causes of bilateral flank pain)
- NHS (UK) (hydronephrosis)
- Sciencedirect (fungal bezoar)
- Mayoclinic (renal cancer)
- Patient.co.uk (IgA nephropathy — Berger’s disease)
- Cystinuria.com (cystinuria symptoms)
- Rarediseases.info.nih.gov (loin pain hematuria syndrome — LPHS)
- Patient.co.uk (polycystic kidney disease)
- Medlineplus (nephrocalcinosis)
- Medlineplus (bilateral hydronephrosis)
- Medlineplus (kidney failure)
- Healthboards.com (kidney stones)
- Igansupport.org (IgA nephropathy)
- Merckmanuals (renal vein thrombosis)
- Merckmanuals (renal artery stenosis)
- Med.miami.edu (renal vascular disease)
- Radiopedia.org (nutcracker syndrome)
- PubMed (loin pain hematuria syndrome in women)
- John Hopkins University (Ureteropelvic junction obstruction)
- PubMed Central (alcohol)
- Patient.co.uk (urinary tract obstruction)
- National Heart, Lung and Blood Institute (vasculitis)
- Americam Family Physician (post-streptococcal glomerulonephritis symptoms)
- Drugs.com (acute renal failure)