Hello. For the past two weeks I’ve been having moderate to severe pain in my back on the left side only below my ribs. The first time this pain appeared was on a Saturday and lasted for 4 to 5 hours. The pain was very intense to the point where I was in tears but I was unable to leave work to go to an ER and the pain had decreased to a moderate pain by the time I left work. The next day the pain intensified again lasting 3 hours before going to the ER. While in the ER the doctor had not taken any imagining only a urine sample, blood draws and provided Torodol via IV. After the UA was complete I was told it appears to be a UTI; was giving a prescription for antibiotics and sent home. I followed up two days later with a family care PCP [not my primary as she is not available right now] who did not do a physical exam and said he did not believe my issue to be a UTI. That doctor did x-ray imaging of my back to rule out any skeletal issues. The x-ray came back to show only minor degenerative disc disease. Another blood draw and UA was done at the appointment. A few days later the doctor called and informed me that my creatinine levels had risen and would like to follow up a week from the previous appointment. At that follow up he expressed concern about kidney function but brushed it off due to my age. My mother-in-law is a RN and has also expressed concern for my kidneys. To date no imaging of my kidneys have been done. Also, the day before my follow up the intense pain had returned but was not only in my back/flank but in my upper abdomen. It felt like a tearing pain under both ribs and there was a throbbing under my ribs in the center of my upper abdomen, you could both feel and see the physical throbbing. This pain again was sudden but was also episodic, coming in waves, lasting between 2 and 10 minutes at a time for 3 hours. I did not go to ER at that time due to having an appointment the next day. Though I admit now I should have gone as the pain was also in my chest and it was difficult to breath during the points of intense pain. I am 31 years old, transgender (FTM), with high blood pressure; I’ve been on BP medication for less than 1 year even though my blood pressure has been elevated for years, and overweight (5’1, 220lbs). In this time three blood draws have been done in order or draw my creatinine has been 1.36, 1.39 and 1.26; BUN has been 10, 10, 11 making BUN/Creatinine Ratio 7.4, 7.2, 8.7. My question is, if this is anything to have concern over and to seek out a nephrologist’s assistance. I have not been confident in the doctor’s actions the two times I have seen him but do not know what to do next. Thank you for any guidance you are able to provide.

I am not able to make a specific diagnosis based on the information that you present. I also think you need further testing that might include a helical computerized axial tomogram (CAT) scan and looking for kidney stones. An ultrasound examination of your kidneys could be another possibility. I agree with you that you need further examination. I am not sure that a nephrologist would be the best individual to consult. I suggest that you persist in seeing your primary care physician (PCP) until this pain is fully evaluated and a proper diagnosis is made. If stone disease is found, then referral to a urologist may be appropriate.

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