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Nephrology/flank discomfort


Hi Dr. Falk,

You were so great answering my questions about BP that i would like to ask another of you.

Since mid December, i have had a dull ache in the right flank area just under the right rib sort of as if you put your open hand toward the back side of your waist.  I kept attributing it to muscle pain, but have noticed over the past two or three months that i have bubbly pee.  It looks like the toilet bowl has been sipping abit too much champagne or sparkling water.  Is there anything over the counter which might help this problem.  Any advise would be very greatly appreciated.

Could the high bp be causing this?  i'm on Micardis 80 HCT now but the results have been as they always are- i get a few points down -this morning was 163/106 about 1 hr after taking the medication.  

thanks again for your help!!!


Hello, Andey,  good to hear from you again.

Firstly,  your blood pressure control is dreadful and over the intermediate to long term, is a significant danger to your health.  I would suggest that you get on your physician's case and get it controlled, i.e., less than 140/90. In any case, I don't think it is causing your flank discomfort or bubbly urine.

Bubbly or foamy urine in quite common and is usually of no consequence.  It has been reported to occur in conditions that are associated with the excretion of abnormal amounts of protein into the urine, but generally, no cause is found.  Some feel that it is related to the velocity of urine flow into the toilet bowl.  It would be prudent for you to have a urinalysis performed to exclude the presence of protein, but other than that I would not worry about it.

Generally speaking, the vast majority of back and flank pain is not of renal origin.  It is true that infection within the kidney can cause back pain but these cases are almost associated with fever and other signs and symptoms of urinary infection.  

Kidney stones can result in back/flank pain but the pain is quite characteristic.  It is usually extremely severe (one of the few things that will make a grown man cry) and comes in waves, waxing and waning but never quite going away until the stone passes.  Almost always, the urine is either grossly bloody or blood is found on microscopic examination of the urine.  In contrast to musculoskeletal pain, the patient moves constantly, unable to find a comfortable position.  In contrast, patients with musculoskeletal  pain find a position that doesn't hurt and want to remain in that position, afraid to move because the pain might return.

The vast majority of back/flank pain is of the musculoskeletal variety. It is treated with NSAIDS like ibuprofen as well as heat, usually administered via a heating pad.  Beware, however,  as NSAIDS cause the kidney to retain salt and can aggravate high blood pressure and your's needs no aggravation right now. You might want to try Tylenol and heat for a few days and if the pain persists, see your physician for an can get your urine checked and BP addressed at the same time.

Now there are unusual causes of back pain that are more urgent, pancreatitis, expanding aneurysms and the like.  These are less likely, but if the discomfort persists or worsens it needs to be evaluated more fully.

Hope this useful to you.  Feel free to follow up if you wish.


Dr Falk


Just reviewed your earlier posts, so I am now less concerned about your BP as you seem to be on the beam with it.  Nevertheless, it still needs to come down to less than 1430/90(I know you know this), either with meds or with more sophisticated measures such as renal nerve deneveration.

Dr Falk  


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Newell R. Falkinburg, M.D., FACP


I am a board certified nephrologist and emeritus professor of medicine at a major medical school and past Director of Nephrology & Hypertension at a university affiliated hospital. I have expertise in all areas of clinical nephrology, dialysis, transplantation and plasmapheresis.


Professor of medicine Director of Nephrology


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