Help help! What is perinephric straining???

  1. Hi guys -

    This is so lame, I know it. I apologize in advance.

    I went to see my doc today for back/flank pain and hematuria. I had about a week of back/flank pain, and finally did a dip-stick UA -- you don't have to drop a house on me.... Small amount of blood (none visible). Called up doc, and got Cipro for 5 days.

    Pain carried on pretty much unchanged for about another week, and then I've had a week pain-free. Pain came back yesterday afternoon, and I did another dipstick UA and this time I had moderate blood and protein. Also some ketones, but the was also high, so obviously some dehydration going on.

    So. Pain's worse, dipstick is worse, so I call the doc and say I need to be seen. Okay. Doc sends me off to the lab for SGPT, SGOT, lactic acid.....I don't remember what-all else. Then I went off to radiology for a spiral CT, to rule out renal calculi.

    I got home and the lab calls my home number, asking for my DOC!! Apparently the people who collected the blood entered my phone number instead of his. So I'm immediately all paranoid, of course. There must be some panic value, right?

    So, carrying on being paranoid (and uncomfortable as he!!, I might add), I called the radiology line and listen to my CT reading. They didn't find any renal calculi, but I've got cholilithiasis!! Several stones > 1 cm. Great.

    But there was a line that I just didn't understand, the radiologist said that perinephric straining was noted bilaterally.

    What the heck is that???? Is it just evidence of straining at stool or something tha is manifested in the perinephric area???

    I'll call doc in the morning, but I'm just a patient, I'm sure I'll wait hours and hours for a callback.

    If anybody can give me a clue, I'd appreciate it. Very much.


  2. 17 Comments

  3. by   aus nurse
    Oh Dennie don't apologise, I have no idea either!

    All I know is that perinephric means around the kidney. But as to how that can be strained I have no clue.

    Sorry to hear you are unwell, hope it all turns out to be easily fixable....keep us posted

    Take care :kiss
  4. by   NurseDennie
    Thanks aus nurse. That was all I could get from it. Straining..... So of course, in my fevered imaginings, I've torn my kidneys out from having constipation. Sheeeeesh

    You know, if it's not one thing, it's several dozen others.


  5. by   ageless
    try this page in the merck manual site:

    Hope this is helpful..
  6. by   live4today
  7. by   aimeee
    Ouch! Hope you can get everything fixed quickly and with a minimum of hassles!
  8. by   NurseDennie
    Thanks guys!

    I got that info from listening to the radiology report. Another doc suggested that what she (radiologist) meant was perinephric STRANDING. And *that* I could find - it's a secondary sign of ureteral obstruction.

    So I guess it's kind of a mixed report, huh? They didn't *see* any stones, and the spiral CT is the modality of choice, and has 95% specificity and 95% sensitivity. I guess maybe it's possible that I already maybe passed a stone and I just have residual pain???

    The proteinuria from yesterday scared me, so I just went and did another dipstick UA. Blood is in the "large" region and no protein. I guess I'm relieved? I don't know.

    I am diabetic, so of course, the possibility of kidney failure is something I think about (especially when I had protein in the urine!) I held my metformin last night and this morning, so if I do end up having to have an IVP, at least I'm ready for it.

    So what do you think? Should I:

    1) Sit tight and wait for the doc to call me back. He said he was going to be sending me to a renal guy anyway, so maybe he's talking with somebody.

    2) Call the office and ask to be seen AGAIN so I can be sure of getting the information. As opposed to having a call from the NONNURSE in his office and getting second-hand information filtered through somebody who didn't demonstrate understanding of ANY of the blood tests.

    3) STOP doing dipstick UA's and scaring myself, and just shut up

    4) Begin drug-seeking behavior and just ride this out.

    5) Some other option, which you will specify?

    6) Nothing. There is no sixth option.


  9. by   NurseDennie
    Hi again. I rang my doctor twice yesterday and he didn't ring me back! He told me he was going to send me to a specialist no matter which way the CT turned out, and I imagine that is going on, but I think he owes me a FYI call, don't you?

    So, today my plan is to be the squeaky wheel and be so annoying that somebody BEGS that man to talk to me. Like I said before, I don't want a call from somebody in the office who can't possibly answer any questions!


  10. by   zumalong
    Been there done that. Same thing happened to me after my son was born. I began having severe right sided pain. It was diffuse at times--but I knew that it was not like any kind of pain I had ever had (or would want again)

    I was breast feeding-so I waited until the pain episodes occured more than 3 times (wouldn't want to go to the doc until I was not able to diagnose my own self first you know.) I had various tests done. U/S showed cholelithiasis and Left sided renal calc in pelvis of kidney.

    Since I was not having any sxs on left side a cholecystectomy was decided to be my tx. I pumped milk for weeks to have enough to feed my 4 month old during the two days or so that I was not able to nurse. (I remember once my mom got out a bag with a good 6 ounces, warmed it up--Sean did not want it--so she had to throw out--I was in tears) Anyway, I had surgery. Lap chole. Fast recovery. All is well.

    Except 1 week later I begin having the pain again, only this time I am not able to void--and am having bladder spasms. Go to ED--CT scan shows calc in ureter/bladder junction. I am having spasms because the stone is trying to pass and can't. It was nasty

    I had a ERCP and guess what pain went away. Amazing. I still wonder if they could have left me with my gallbladder and done the lithotripsy in the first place. Well I was able to experience conscious sedation on the other side of the bedrail.

    Good luck keep me informed of what they find. It sounds suspiously like what I went through.

    Take care. Cheryl:kiss
  11. by   NurseDennie
    Thanks, Cheryl. It does sound familiar, doesn't it? I almost wish they'd been able to visualize a kidney stone, because then I'd be able to stop worrying about it!

    My question is the same as yours - why didn't they get rid of your kidney stone when they first found it? Surely they knew it was going to cause problems sooner or later, didn't they?

    My liver tests came back WNL (got the bloody call from the bloody MA, not the doc. Grrrr!!!) so I can go back on meds. No other word, though.

    I can't seem to make myself stop the dipstick ua's though. Seems like the response for the blood was a bit less this morning, and definitely less protein. I'm afraid whatever is causing the pain might be causing me permanent damage???

    I'm so paranoid that yesterday, during a particularly unpleasant moment, I was trying to figure out how I'd do my work schedule when I have to go on dialysis!!

    So obviously, I don't have a LOT of objectivity about this. The pain is wearing me down. I think I'll sit in the doc's office tomorrow after I see my patients. Maybe I'll ge some pain meds to at least get me through the weekend.

    Thanks so much for caring about this and me, and for letting me blather on and on and on with this whining.


  12. by   Jenny P
    Dennie, when you're in pain doesn't matter if you're paranoid or not. As nurses, we KNOW of every single terrible thing that COULD go wrong with the human body. STOP TESTING YOUR URINE! As you said yourself, it's making you paranoid. Take care of yourself; it's bad enough that you have pain; why make yourself crazy also? (Give the dip sticks to someone else to hide from you for a week- or until you see the specialist).
    I have no idea what perinephric straining (or stranding) is; but I'll say a few prayers for you. I think you need to see the specialist with a written list of questions for him to answer. Good luck, and God bless.
  13. by   aus nurse
    aus hands dennie the 12-step program of recovering from dip-sticking addiction :chuckle

    Sorry dennie, don't mean to make light of your situation girl....just made me giggle the image of you feverishly dipping away!

    Good luck in passing that damm calculi, coz it sure sounds like that is what you have. Yes, get some pain relief if that doc not doing anything else in the meantime.

    Keep harassing him for answers...

    Take care my friend :kiss
  14. by   Mary Dover
    Dennie....(((((((((((HUGS)))))))))) Hoping and praying that you feel better soon. Take care my friend.