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Kidney Pain

• When to See a Provider

Frequently Asked Questions

There are many reasons why you may experience kidney pain, some of which are more serious than others. The pain may be the sign of an infection, injury, or another health concern, like a kidney stone .

Because the pain is experienced inside the body, it can sometimes be confused with muscular back pain . The symptoms can also vary based on the underlying cause, ranging from a dull, creeping ache to a deeply intense pain accompanied by vomiting and fever.

This article describes the signs and symptoms of kidney pain and what the pain may suggest about the underlying cause. It also looks at how kidney pain is diagnosed and treated, and when it is time to seek medical treatment.

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Symptoms of Kidney Pain

The kidneys are two bean-shaped organs about the size of a clenched fist that are part of the urinary tract . The urinary tract is responsible for making urine (pee) and removing it from the body.

Kidney pain, also known as renal pain , can be felt where the kidneys are located: in the middle of the back, on either side of the spine, and just under the ribcage. Sometimes, the pain will be situated on the side of the body between the upper abdomen and back, where it is referred to as flank pain.

The kidney pain may be unilateral (on one side of the body) or bilateral (on both sides). It can also be acute (rapidly developing and typically intense) or chronic (gradually developing and persistent).

Kidney pain often feels like a dull ache that gets worse when someone presses on the overlying area. However, certain conditions can trigger intense and even excruciating pain accompanied by symptoms such as:

• Fever with chills
• Pain with urination
• Blood in the urine
• Fatigue and tiredness
• Nausea or vomiting

Because the pain is often dull, it can be difficult to tell if it is arising from the kidneys or from surrounding muscles, bones, or organs. It is not uncommon for people to mistake kidney pain for back pain, although there are several key ways to tell them apart.

The pain is felt higher in the back and deep in the body.

The pain tends to be dull (although some conditions can cause sharp, stabbing pain).

The pain can be felt on one side or both sides of the back.

The pain generally will not go away if you shift your body or rest.

The pain typically is felt in the lower back.

The pain tends to be sharper and can cause shooting pains down one leg.

The pain usually will get worse with activity, such as when bending over or lifting heavy objects.

The pain can improve when you shift your body or rest.

Common Causes of Kidney Pain

There are many different causes of kidney pain, some of which are acute and others that are chronic. In some cases, the symptoms can hint at the underlying cause.

Kidney Stones

Kidney stones , also known as renal calculi , are among the most common causes of kidney pain. Kidney stones can form when there is an excessive concentration of specific substances in the urine.

 Kidney pain arises as the stone moves downward through the kidney, ureter, bladder , and ultimately through the urethra (the tube through which urine exits the body),

The pain from a kidney stone is typically severe and felt in either the back or the flank area. The pain may also be accompanied by nausea, vomiting, fever, chills, pain with urination, frequent urination, and blood in the urine.

Unlike most causes of kidney pain, the pain from kidney stones can improve as you switch positions or lie down to rest.

Urinary Tract Infections

Urinary tract infections (UTIs) are caused by bacteria that enter the urinary tract. This not only causes pain when you urinate, known as dysuria , but can lead to fever and the need to urinate frequently .

While most UTIs affect the bladder and urethra, the infection can sometimes travel upstream and affect the kidneys as well. This type of infection is known as pyelonephritis .

Pyelonephritis can cause pain in the back, flank, or groin areas. There will often be fever and chills as well as frequent urination, burning with urination, blood in the urine, and smelly or cloudy urine. Nausea and vomiting are also common.

Dehydration

Dehydration (not having enough water in the body) can sometimes cause kidney pain. Dehydration can be caused by severe vomiting and diarrhea, excessive sweating or urination, or certain health conditions such as diabetes .

The kidney pain caused by dehydration tends to be dull and felt in the middle of the back on both sides. There may also be fatigue, headache, excessive thirst, sunken eyes, dizziness, reduced urination, and dark urine.

Severe cases can cause tachycardia (rapid heartbeats), tachypnea (rapid breathing), and confusion.

Dehydration can cause a buildup of wastes in the body and clog the kidneys with muscle proteins known as myoglobin . Dehydration can also contribute to the development of kidney stones and UTIs, both of which can cause kidney damage if not treated appropriately.

Kidney Trauma

Sometimes the kidneys can be physically injured, such as during contact sports, a severe fall or blow, or an automobile accident. The injury, referred to as a renal contusion , can cause a dull, aching pain or sharp, stabbing pains depending on the severity of the injury.

The pain may not be immediately apparent but will often progress over the course of hours or days. In addition to pain, there may be localized bruising, tenderness to the touch, nausea or vomiting, and blood in the urine.

Kidney trauma should not be confused with acute kidney injury (AKI) , a typically reversible form of kidney failure that causes the kidneys to temporarily "shut down."

Polycystic Kidney Disease

Polycystic kidney disease (PKD) is a genetic disorder that causes fluid-filled cysts to form inside the kidneys. Over time, the accumulation of cysts can cause the kidneys to enlarge, triggering chronic back, side, or flank pain. Both kidneys will be affected.

Because the kidneys are involved in the regulation of blood pressure, people with PKD often have hypertension (high blood pressure). Other possible symptoms include headaches, blood in the urine, a feeling of abdominal fullness, and increased abdominal size.

People with PKD are at an increased risk of kidney stones and kidney failure.

Does Kidney Failure Cause Pain?

Kidney pain is also not a typical sign of kidney failure. With kidney failure, you are more likely to feel pain in the joints and muscles than in the kidneys due to the accumulation of toxins and depletion of electrolytes in your blood.

Kidney Cancer

A less common cause of kidney pain—but one that is especially important to be aware of—is kidney cancer. The most common form, called renal cell carcinoma , accounts for nine out of every 10 cases.

Kidney cancer is often asymptomatic (without symptoms) during the early stages and will often only cause symptoms when the disease is advancing.

When symptoms do develop, they often include pain in the side or flank area as well as chronic fatigue, blood in the urine, unintended weight loss, and a physical mass in the flank area.

Kidney cancer is the fifth most common cancer and the eighth most common cause of cancer-related deaths in the United States. In 2022, there were an estimated 79,000 new cases of kidney cancer in the United States and around 13,920 deaths.

Medications

There are many medications that are nephrotoxic , meaning toxic to the kidneys. Most do not cause harm when used as directed for a limited time. However, if you have underlying chronic kidney disease (CKD) or take the drugs excessively, they can injure the kidneys and cause pain.

The pain will typically be dull and felt in both kidneys. In addition to pain, there may be reduced urination, fatigue, itching, nausea, vomiting, a loss of appetite, and confusion. If the medications are not stopped, permanent kidney damage can occur.

Among the drugs that may be harmful to the kidneys are:

• Antibiotics like Vancocin (vancomycin), Cubicin (daptomycin), and Vibativ (telavancin) when taken in high doses by hospitalized people or people with kidney disease
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Aleve (naproxen), and Advil (ibuprofen)
• Prescription laxatives , particularly those containing sodium phosphate used for bowel clearance
• Certain intravenous (IV) contrast dyes , used to enhance imaging for X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) scans
• Alcohol and illegal drugs like cocaine, heroin, and crystal methamphetamine

How to Treat Kidney Pain

The treatment of kidney pain varies by the underlying cause. Some cases can be treated at home, while others require nothing more than the discontinuation of the offending drug. Others still may require aggressive treatment by a kidney specialist, known as a nephrologist . Certain conditions like kidney stones are treated by urologists.

If you have been diagnosed with a kidney stone, the treatment plan will be largely based on the size of the stone itself and includes:

• Smaller kidney stones : Smaller stones can often be treated by drinking ample quantities of water—as much as 2–3 quarts per day—to help ease their passage from the body. Alpha-blockers like Flomax (tamsulosin) and Jalyn (dutasteride and tamsulosin) can help relax the muscles of the urinary tract, while over-the-counter (OTC) pain relievers like Tylenol can help ease the pain.
• Larger kidney stones : Extracorporeal shock wave lithotripsy (ESWL) is a procedure that uses sound waves to break larger stones into tiny pieces so they can be easily passed. A stone can also be removed by inserting a tiny fiber-optic scope (called a urethroscope) into the urethra or by performing percutaneous nephrolithotomy which accesses a stone using tiny scopes and instruments inserted through small incisions in your back.

UTIs are commonly treated with oral antibiotics . Uncomplicated pyelonephritis responds especially well to fluoroquinolone antibiotics but can also be treated with extended-release penicillins , cephalosporins , and Bactrim (trimethoprim-sulfamethoxazole).

The kidney pain may be eased with Tylenol (acetaminophen), gentle heat application , or taking a warm bath with Epsom salts . Ensuring ample hydration is also important.

Rehydration is the primary treatment for dehydration. This may involve oral solutions like Pedialyte for mild to moderate dehydration, while severe cases may require intravenous rehydration (in which fluids are delivered through a vein in your arm).

Drinking plenty of water can dilute the concentration of urine, which, in turn, helps relieve kidney pain. While electrolyte-rich sports drinks can be useful for milder cases of dehydration, they often contain excessive amounts of sugar that can irritate the kidneys. Rehydration with water remains the best option.

The treatment of a renal contusion is based on the severity of the injury. Milder cases often only require bed rest and supportive care with OTC painkillers, gentle heat application, and ample fluids.

Severe injuries may require angioembolization in which a flexible tube (catheter) is fed through a vein in your groin to the site of the injury to stop bleeding by occluding (blocking) the vessel. Other injuries may require laparoscopic ("keyhole") surgery or open surgery to repair the damage.

Because NSAIDs promote bleeding, mild to moderate pain is often managed with non-NSAID painkillers like Tylenol. For severe pain, NSAIDs may be used with caution, either alone or with an opioid (narcotic) painkiller .

Polycystic kidney disease (PKD) is typically treated with a combination of self-care, OTC or prescription drugs, and specialist treatments like cyst aspiration (in which large cysts are drained in a minimally invasive surgical procedure).

Drinking more water also prevents the cysts from enlarging. Pain management is central to the treatment of PKD. This may involve OTC painkillers like Tylenol or Advil or stronger prescription drugs like Tylenol #3 (acetaminophen and codeine) or Ultram (tramadol).

In 2018, the Food and Drug Administration (FDA) approved  Jynarque (tolvaptan) , an oral medication that can slow cyst formation in people with PKD. Studies have shown that Jynarque can also reduce kidney pain in people with rapidly progressing PKD.

Renal cell carcinoma can be treated with surgery. This can reduce kidney pain even if the cancer has spread to other organs. People who cannot withstand surgery may be treated with cryosurgery (in which the tumor is destroyed with freezing) or radiofrequency ablation  (in which the tumor is destroyed with electricity).

While chemotherapy and radiation therapy may be involved in the treatment plan, targeted drugs like Sutent (sunitinib) and Nexavar (sorafenib) and immunotherapy drugs like Keytruda (pembrolizumab) and Opdivo (nivolumab) have taken a more central role in the treatment of renal cell carcinoma.

Depending on the stage of cancer, the pain may be managed with opioid drugs like fentanyl , alfentanil, or sufentanil. Severe cases may benefit from morphine.

Are There Tests to Diagnose the Cause of Kidney Pain?

If you experience kidney pain, your healthcare provider typically will order lab tests to check for abnormalities in your blood or urine. Imaging tests will also be used to visualize the kidneys indirectly.

One of the first tests your healthcare provider will order for kidney pain is a urinalysis . The test evaluates the composition of your urine to identify signs of kidney problems, including excessive proteins or red blood cells . Microscopy may also be performed on the urine sample. A urine culture can also be performed to check for bacterial or fungal infections.

Blood tests will also be ordered to evaluate your kidney function and check for signs of infection or inflammation. These typically include:

• Serum creatinine (SCr) : Measures how efficiently your kidneys are able to clear a waste product known as creatinine from the body
• Estimated glomerular filtration rate (eGFR) : Calculates how much blood is being filtered by the kidneys
• Blood urea nitrogen (BUN) : Measures how efficiently your kidneys are able to clear a waste product called urea from the body
• C-reactive protein (CRP) : Looks for markers of inflammation in the bloodstream
• Erythrocyte sedimentation rate (ESR) : Checks for inflammation based on how quickly blood cells fall to the bottom of a test column

Imaging Tests

There are several imaging tests that help pinpoint the cause of kidney pain whether it be due to an infection, trauma, or disease. These include:

• Ultrasonography : Uses high-frequency sound waves to create high-contrast images of the internal structure of the kidneys
• Computed tomography (CT) : Puts together a series of X-ray images to create three-dimensional "slices" of the kidney
• Magnetic resonance imaging (MRI) : Uses powerful radio waves and magnetic fields to create highly detailed images of the kidneys

Specialist Procedures

There are times when more invasive procedures are needed to either diagnose the cause of kidney pain or confirm the diagnosis. These include:

• Cystoscopy : Involves the insertion of a flexible or rigid scope into the urethra to view the bladder
• Ureteroscopy : Involves the insertion of a flexible scope into the urethra to view the kidneys and ureters (which connect the kidneys to the bladder)
• Fine needle aspiration (FNA) : A type of biopsy in which a needle is inserted through the back to obtain cells from a kidney tumor
• Core needle biopsy : A type of biopsy similar to FNA that involves a larger needle to obtain a cylindrical sample of tissue

When to See a Healthcare Provider

You should see a healthcare provider if your kidney pain is persistent or worsening. Even if the pain is dull, there is no such thing as "normal" kidney pain. It is in your best interest to have it looked at.

You should see a healthcare provider immediately if the kidney pain is accompanied by:

• Cloudy and/or smelly urine
• Solid fragments or grains in the urine
• Frequent urination
• Reduced urination

When to Call 911

Seek emergency care if you develop sudden, severe kidney pain with or without blood in the urine. You should do the same if you have kidney pain and are suddenly unable to urinate. This may be a sign of a urinary tract obstruction , which can turn deadly if not treated immediately.

Kidney pain can be caused by many different things. Unlike back pain, which it mimics, kidney pain is usually felt in the upper back and will usually not improve by shifting positions or resting.

Common causes of kidney pain include kidney stones, kidney infection, dehydration, kidney trauma, polycystic kidney disease, and kidney cancer. The pain will often resolve when the underlying condition is treated. Over-the-counter or prescription painkillers, heat therapy, and ample hydration can help ease the discomfort and pain.

One of the reasons why people mistake kidney pain for back pain is that they don't actually know where their kidneys are. The kidneys are located higher up than many people imagine, housed on the lower portion of the rib cage and not in the middle of the back where "kidney punches" are thrown in movies and on television.

If you're uncertain whether your pain is stemming from your back or your kidneys, it is best to have it checked by a healthcare provider. If your primary care provider is unable to see you, there are telehealth nephrologists and urologists you can turn to, many of whom may be covered by insurance.

Kidney stones are the most common cause of kidney pain. Symptoms include a sharp, stabbing pain in the back or side that often starts suddenly and comes in waves. The pain will often move to the lower abdomen or groin as the body tries to rid itself of the hardened mineral deposit.

Kidney stones will often cause pain right before bedtime or just as you awaken because these are the times when you are less likely to urinate. During these times, the ureters that connect the kidneys to the bladder will constrict (narrow) to prevent urination. This, in turn, can intensify pain if you have kidney stones.

The symptoms of a kidney infection can overlap with a bladder infection but tend to be more severe. This is because the infection will have traveled upstream from the urethra and bladder to the ureters and kidneys. Symptoms include severe abdominal pain, nausea, vomiting, fever, chills, and pain on either one or both sides of the back.

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By James Myhre & Dennis Sifris, MD Dr. Sifris is an HIV specialist and Medical Director of LifeSense Disease Management. Myhre is a journalist and HIV educator.

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A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives

1 Diabetes Resource Centre, University Hospital Llandough, Penlan Road, Llandough, Cardiff, CF64 2XX UK

Ruth D. Lewis

2 Health Economics and Outcomes Research Ltd, Cardiff, UK

Angharad R. Morgan

Martin b. whyte.

3 Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

Wasim Hanif

4 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Stephen C. Bain

5 Diabetes Research Unit, Swansea University Medical School, Swansea, UK

Sarah Davies

6 Woodlands Medical Centre, Cardiff, UK

Umesh Dashora

7 East Sussex Healthcare NHS Trust, Eastbourne, UK

Zaheer Yousef

8 Department of Cardiology, University Hospital of Wales and Cardiff University, Cardiff, UK

Dipesh C. Patel

9 Division of Medicine, Department of Diabetes, University College London, Royal Free Campus, London, UK

W. David Strain

10 Diabetes and Vascular Research Centre, University of Exeter Medical School, Exeter, UK

Chronic kidney disease (CKD) is a complex disease which affects approximately 13% of the world’s population. Over time, CKD can cause renal dysfunction and progression to end-stage kidney disease and cardiovascular disease. Complications associated with CKD may contribute to the acceleration of disease progression and the risk of cardiovascular-related morbidities. Early CKD is asymptomatic, and symptoms only present at later stages when complications of the disease arise, such as a decline in kidney function and the presence of other comorbidities associated with the disease. In advanced stages of the disease, when kidney function is significantly impaired, patients can only be treated with dialysis or a transplant. With limited treatment options available, an increasing prevalence of both the elderly population and comorbidities associated with the disease, the prevalence of CKD is set to rise. This review discusses the current challenges and the unmet patient need in CKD.

Key Summary Points

Introduction.

Chronic kidney disease (CKD) is a complex and multifaceted disease, causing renal dysfunction and progression to end-stage kidney disease (ESKD) and cardiovascular disease. Complications associated with the disease contribute to the acceleration of CKD progression and risk of cardiovascular-related morbidities.

Despite its high prevalence and the clinical and economic burden of its associated complications, disease awareness remains profoundly low. Worldwide, only 6% of the general population and 10% of the high‐risk population are aware of their CKD statuses [ 1 ]. In addition, CKD recognition in primary care settings is also suboptimal, ranging from 6% to 50%, dependent upon primary care specialty, severity of disease, and experience. Awareness of CKD remains low in part because CKD is usually silent until its late stages. However, diagnosis of CKD during the later stages results in fewer opportunities to prevent adverse outcomes. Physician awareness of CKD is critical for the early implementation of evidence-based therapies that can slow progression of renal dysfunction, prevent metabolic complications, and reduce cardiovascular-related outcomes.

Currently CKD is not curable, and management of the disease relies on treatments which prevent CKD progression and cardiovascular disease. Despite available treatments, a residual risk of adverse events and CKD progression remains. This article reviews the challenges associated with CKD and the treatments available for patients, highlighting the unmet need for cardio-renal protection in patients with CKD.

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

CKD Prevalence

CKD is a global health problem. A meta-analysis of observational studies estimating CKD prevalence showed that approximately 13.4% of the world’s population has CKD [ 2 ]. The majority, 79%, were at late stages of the disease (stage 3–5); however, the actual proportion of people with early CKD (stage 1 or 2) is likely to be much higher since early kidney disease is clinically silent [ 3 ].

Prevalence of CKD appears to be growing rapidly both in the UK and in the Western world. Based on the 2012 subnational population projections for England [ 4 ], the number of people with CKD stage 3–5 is projected to exceed 4 million by 2036 [ 5 ]. This rise in CKD prevalence is due to an increased aging population and prevalence of type 2 diabetes (T2DM), obesity, hypertension and cardiovascular disease that contribute to CKD [ 6 – 8 ].

The World Health Organization (WHO) estimated that the annual, global number of deaths caused directly by CKD is 5–10 million [ 9 ]. The presence of CKD advances mortality of comorbidities such as cardiovascular diseases, T2DM, hypertension, and infection with human immunodeficiency virus (HIV), malaria and Covid-19, thereby indirectly adding to CKD mortality [ 9 , 10 ]. A contributing cause of high morbidity and mortality associated with CKD is a lack of awareness of the disease, by both patients and providers [ 11 , 12 ]. Early stages of CKD are clinically silent and patients have no symptoms. Lack of treatment at this stage allows CKD to progress through to advanced stages of the disease, where patients may present complications and/or cardiovascular-related comorbidities, or ESKD. Raising awareness of CKD is therefore paramount to allow for early intervention and reduce the risk of comorbidities and mortality.

Classification of CKD

In order to better manage CKD and provide better care for patients, the classification of CKD was developed by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative [ 13 ] and the international guideline group Kidney Disease Improving Global Outcomes (KDIGO) [ 14 ]. CKD stratification is based upon the estimated glomerular filtration rate (eGFR) and albuminuria.

There are six eGFR categories. An eGFR of less than 60 mL/min per 1.73 m 2 for more than 3 months is indicative of impaired renal function and the severity of kidney damage increases with decreasing eGFR measurements. Patients with early onset of the disease, stage 1–2, have normal to mild decreased levels of eGFR (60 to ≥ 90 mL/min per 1.73 m 2 ). Patients with stage 3a–3b have mild to moderate decreased levels of eGFR (45–59 mL/min per 1.73 m 2 , respectively). Severely decreased levels of eGFR, stage 4–5 (15–29 to < 15 mL/min per 1.73 m 2 , respectively), are indicative of advanced stages of the disease and kidney failure.

Stratification also comprises three categories of albuminuria. Patients with an albumin to creatinine ratio (ACR) of 3 to at most 30 mg/mmol are classified as having microalbuminuria and at moderate risk of adverse outcomes. Those with ACR of greater than 30 mg/mmol are classified as having macroalbuminuria and being severely at risk of developing adverse events [ 15 ]. The eGFR and albuminuria categories independently predict adverse outcomes for patients with CKD, and the combination of both increases this risk further [ 16 ]. The CKD classification system aids clinicians in carrying out accurate assessments of CKD severity and other complications which helps to inform decisions associated with the management and monitoring of patients [ 3 , 17 , 18 ].

Clinical Burden of CKD

CKD is a complex disease, involving both non-modifiable (e.g. older age, family history and ethnicity) and modifiable risk factors (e.g. T2DM, hypertension and dyslipidaemia) which are responsible for the initiation of early CKD, CKD progression (stage 3–5) and ESKD.

In early stages of CKD (stage 1–2), factors such as hypertension, obesity and T2DM can trigger kidney function impairment. This causes glomerular/interstitial damage and results in impaired glomerular filtration, leading to decreased eGFR and increased albuminuria. At this stage, even though clinical symptoms do not present, the presence of additional risk factors, including hypertension, hyperglycaemia, smoking, obesity, dyslipidaemia and cardiovascular disease, may accelerate CKD progression and result in ESKD.

As the disease progresses, the clinical and economic burden of CKD increases (Fig.  1 ) as complications such as CKD mineral bone disorder, anaemia, hypertension and hyperkalaemia may occur and advanced stages of CKD, stage 4–5, ensue. Clinical symptoms, such as fatigue, itching of the skin, bone or joint pain, muscle cramps and swollen ankles, feet or hands, are often present at this stage [ 19 ]. Further deterioration of kidney function causes tubular and glomerular hypertrophy, sclerosis and fibrosis, leading to a significant reduction in eGFR, extreme albuminuria and kidney failure.

A schematic diagram showing the association between CKD progression and clinical and economic burden. Symptoms of CKD typically present during advanced stages of the disease where patients are at increased risk of cardiovascular disease and other comorbidities

Even though CKD progression may lead to kidney failure and renal death, patients with CKD are more likely to die from cardiovascular-related complications before reaching ESKD [ 20 ]. A study using data from a meta-analysis involving 1.4 million individuals found a significant increased risk of cardiovascular-related mortality, even in stage 2 of CKD (eGFR levels < 90 mL/min per 1.73 m 2 ) [ 16 , 21 , 22 ].

As the disease progresses, the risk of cardiovascular disease is markedly increased, such that 50% of patients with late-stage CKD, stage 4–5, have cardiovascular disease. The risk of atrial fibrillation (AF) and acute coronary syndrome (ACS) is doubled in patients with eGFR < 60 mL/min per 1.73 m 2 . AF is associated with a threefold higher risk of progression to ESKD. The incidence of heart failure (HF) is also threefold greater in patients with eGFR < 60 mL/min per 1.73 m 2 compared with > 90 mL/min per 1.73 m 2 and HF is associated with CKD progression, hospitalisation and death [ 23 ].

The increased risk of cardiovascular disease in patients with CKD is due in part to the traditional risk factors associated with cardiovascular disease such as hypertension, T2DM and dyslipidaemia. For instance, a large observational database linked study (Third National Health and Nutrition Examination Survey (NHANES) III) found a strong association between CKD and T2DM combined and an increased risk of mortality [ 24 ]. In this study, the authors observed a 31.1% mortality rate in patients with CKD and diabetes, compared to 11.5% in people with diabetes only. An observational study using both US and UK linked databases showed that the presence of both CKD and T2DM was related to increased risk of major adverse cardiac events (MACE), HF and arrhythmogenic cardiomyopathy (ACM) [ 25 ]. This risk was further elevated in older patients with atherosclerotic cardiovascular disease [ 25 ]. Similarly, the presence of both CKD and T2DM leads to a significant increased risk of all-cause and cardiovascular-related mortality versus T2DM alone [ 24 ].

The direct renal effect on cardiovascular disease is due to generalised inflammatory change, cardiac remodelling, narrowing of the arteries and vascular calcification, both contributing to the acceleration of vascular ageing and atherosclerotic processes, and leading to myocardial infarction, stroke and HF [ 26 ].

Together, these studies highlight the strong relationship which exists between CKD progression, number of comorbidities and heightened risk of cardiovascular disease and cardiovascular-related mortality.

Economic Burden of CKD

In addition to the clinical burden, management of CKD also requires significant healthcare resources and utilisation. In 2009–2010, the estimated cost of CKD to the National Health Service (NHS) in England was £1.45 billion [ 27 ]. Furthermore, in 2016, US Medicare combined expenditure for CKD and ESKD exceeded $114 billion (£86 billion) [ 28 ].

Although estimating the true cost of early CKD is difficult because of the lack of data available for unreported cases, CKD progression is associated with increased healthcare costs [ 29 , 30 ]. A study by Honeycutt et al. combined laboratory data from NHANES with expenditure data from Medicare and found that costs of CKD management increased with disease progression [ 29 ]. Estimated annual medical costs of CKD per person were not significant at stage 1, $1700 at stage 2, $3500 at stage 3 and $12,700 at stage 4.

Healthcare costs associated with early CKD are more likely to be from the sequalae of comorbid disease rather than kidney disease. Hence, patients with CKD stage 1 or 2 are at increased risk of hospitalisation if they also have T2DM (9%), cardiovascular disease (more than twofold), and both cardiovascular disease and T2DM (approximately fourfold) [ 31 ].

ESKD accounts for the largest proportion of CKD management costs. In 2009–2010, 50% of the overall CKD cost to NHS (England) was due to renal replacement therapy (RRT), which accounted for 2% of the CKD population [ 27 ]. The other 50% included renal primary care costs, such as treatment costs for hypertension and tests, consultation costs, non-renal care attributable to CKD and renal secondary care costs. Approximately £174 million was estimated for the annual cost of myocardial infarctions and strokes associated with CKD [ 27 ].

More recently, an economic analysis investigated the burden associated with the management of cardiovascular-related morbidity and mortality in CKD, according to the KDIGO categorisation of both eGFR and albuminuria [ 15 ]. Decreased eGFR levels increased both the risk of adverse clinical outcomes and economic costs, and albuminuria elevated this risk significantly. Furthermore, CKD progression correlated with increased CKD management costs and bed days. Stage 5 CKD (versus stage 1 (or without) CKD) per 1000 patient years was associated with £435,000 in additional costs and 1017 bed days.

The significant economic burden associated with CKD progression and ESKD highlights the importance of optimising CKD management and the unmet need for better treatment options in slowing disease progression in this patient population. Thus, early detection and intervention to slow the progression of the disease has the potential to make substantial savings in healthcare costs.

Current CKD Management Strategies

KDIGO and National Institute for Health and Care Excellence (NICE) have produced detailed guidelines for the evaluation and management of CKD [ 3 , 32 , 33 ]. Both recommend implementing strategies for early diagnosis of the disease in order to reduce the risk of cardiovascular disease, attenuate CKD progression and decrease the incidence of ESKD in this patient population. CKD is a complex disease and thus treatment requires a multifaceted approach utilising both non-pharmacological, e.g. diet and exercise regimes and pharmacological interventions such as antihypertensive and antihyperglycemic drugs [ 34 ]. There has, however, been no significant breakthrough in this area for over 2 decades.

The effect of lifestyle intervention on reducing disease progression is still unclear, although increased physical activity has been shown to slow the rate of eGFR decline [ 35 ] and ESKD progression [ 36 ], improve eGFR levels [ 35 ] and albuminuria [ 37 ], and reduce mortality in patients with CKD [ 35 , 38 – 40 ]. Similarly, diet regimes such as low-protein diet or Mediterranean diet reduce renal function decline and mortality rate in CKD [ 41 , 42 ]. Hence, dietary advice is recommended in accordance with CKD severity to control for daily calorie, salt, potassium, phosphate and protein intake [ 3 , 33 ]. However, patients with consistently elevated serum phosphate levels or metabolic acidosis [low serum bicarbonate levels (< 22 mmol/l)], associated with increased risk of CKD progression and death, may be treated with phosphate binding agents (e.g. aluminium hydroxide and calcium carbonate) or sodium bicarbonate, respectively [ 3 ].

To reduce the risk of cardiovascular disease, KDIGO and NICE recommend active lipid management and blood pressure control [ 33 , 43 , 44 ]. In early CKD stages 1 and 2, statins are recommended for all patients over 50 years of age, whilst in stage 3 and advanced stages of the disease, stage 4–5 (eGFR < 60 mL/min per 1.73 m 2 ), a combination of statins and ezetimibe is advised [ 43 ].

Management of hypertension includes a target blood pressure of less than 140/90 mmHg for patients with CKD and hypertension and less than 130/80 mmHg for patients with CKD and T2DM, and also in patients with albuminuria [ 3 , 32 ], alongside blood pressure lowering therapies and renin–angiotensin–aldosterone system (RAAS) blocking agents, such as angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEi). As such, RAAS inhibitors (RAASi) are currently recommended to treat patients with diabetes, hypertension and albuminuria in CKD [ 45 ]. These RAAS blocking agents confer both renal and cardiovascular protection and are recommended as first-line treatment to treat hypertension in patients with CKD [ 34 , 46 ].

The clinical benefits of RAASi have been demonstrated in patients with CKD with and without diabetes [ 47 – 49 ]. These clinical benefits are in addition to their effects on reducing blood pressure and albuminuria, including a reduction in eGFR decline and a decreased risk of ESKD cardiac-related morbidity and all-cause mortality [ 47 – 49 ]. Nevertheless, despite their benefits, RAASi treatment can induce hyperkalaemia, and patients are often advised to reduce RAASi dosage or even discontinue their treatment, which prevents optimum clinical benefits of RAASi therapy being reached. In this instance, combination therapy with potassium binding agents, such as patiromer and sodium zirconium cyclosilicate, may be used alongside RAASi therapy to reduce RAASi-associated hyperkalaemia.

However long-term trials will be required to determine their effect on cardiovascular morbidity and mortality in CKD [ 50 – 52 ]. Despite these therapies being the mainstay of CKD management, there is still a residual risk of CKD progression and an unmet need for new treatments.

Novel/Emerging Treatments for CKD Management

Over the last 2 years, novel therapeutic approaches for CKD management have emerged, with particular attention on mineralocorticoid receptor antagonists (MRAs) and sodium–glucose co-transporter 2 (SGLT2) inhibitors. The clinical effectiveness of finerenone, a selective oral, non-steroidal MRA, has recently been demonstrated to lower risks of CKD progression and cardiovascular events in diabetic kidney disease (DKD) [ 53 ]. Finerenone is under review for approval by the European Medicines Agency (EMA) and US Food and Drug Administration (FDA).

Of these new and emerging therapies, SGTL2i offers the most clinical benefit with both cardiovascular and renal protective effects, independent of glucose lowering. Clinical trials of SGTL2 in T2DM with and without CKD overall showed a 14–31% reduction in cardiovascular endpoints including hospitalisation for HF and MACE and a 34–37% reduction in hard renal-specific clinical endpoints including a sustained reduction in eGFR, progression of albuminuria and progression to ESKD [ 54 – 58 ]. CREDENCE, was a double-blind, multicentre, randomised trial in diabetic patients with albuminuric CKD (eGFR 30 to < 90 mL/min per 1.73 m 2 and ACR ≥ 30 mg/mmol) [ 57 ]. In this trial, canagliflozin reduced the relative risk of the composite of ESKD, doubling of serum creatinine and renal-related mortality by 34%, relative risk of ESKD by 34% and risk of cardiovascular-related morbidity, including myocardial infarction and stroke, and mortality.

The SGTL2i dapagliflozin has proven its effectiveness in slowing CKD progression in addition to reducing cardiovascular risk in early stages of CKD. The DECLARE-TIMI58 trial involved 17,160 diabetic patients with established atherosclerotic cardiovascular disease and early-stage CKD (mean eGFR was 85.2 mL/min per 1.73 m 2 ) and were randomised to receive either dapagliflozin or placebo. Following a median follow-up of 4.2 years, there was a significant reduction in renal composite endpoints with dapagliflozin versus placebo, with a 46% reduction in sustained decline of at least 40% eGFR to less than 60 mL/min per 1.73 m 2 and a reduction in ESKD (defined as dialysis for at least 90 days, kidney transplantation, or confirmed sustained eGFR < 15 mL/min per 1.73 m 2 ) or renal death.

More recently, these cardiovascular and renal protective effects of SGTLT2i have also been demonstrated in a broad range of patients with more advanced stages of CKD (mean eGFR was 43.1 ± 12.4 mL/min per 1.73 m 2 ) without diabetes [ 58 , 59 ]. In the DAPA-CKD trial, many patients were without diabetes, including IgA nephropathy, ischemic/hypertension nephropathy and other glomerulonephritis [ 59 ]. Patients receiving dapagliflozin had a 39% relative risk reduction in the primary composite outcomes of a sustained decline in eGFR of at least 50%, ESKD and renal- or cardiovascular-related mortality and a 31% relative risk reduction of all-cause mortality compared to placebo [ 58 , 60 ]. Safety outcomes from clinical trials of dapagliflozin have also shown similar incidences of adverse events in both placebo and dapagliflozin arms [ 58 , 61 ].

The clinical benefits and safety outcomes from these trials highlight the potential use of SGTL2i in reducing cardiovascular burden and CKD progression in a broad range of CKD aetiologies at early and late stages where there is an unmet need. Currently, SGTL2i class drugs, including canagliflozin, dapagliflozin and empagliflozin, are approved by the US FDA for the treatment of T2DM and, more recently, dapagliflozin and canagliflozin for CKD and DKD respectively [ 62 , 63 ]. In addition, SGTL2i has been recommended for approval in the European Union (EU) by the Committee for Medicinal Products for Human Use (CHMP) of the EMA, for the treatment of CKD in adults with and without T2D [ 64 ]. Hence, there is now a need to raise awareness of the clinical applicability of these drugs in CKD to ensure full utilisation and maximum benefits are met, for both patients and providers.

This narrative review has summarised some of the key challenges associated with CKD. Early stages of the disease are clinically silent which prevents early intervention to slow the progression of the disease and allows progression of CKD and ESKD. At advanced stages of the disease, when clinical symptoms are present, patients with CKD are already at heightened risk of cardiovascular-related morbidity and mortality. Hence, advanced stages of CKD and ESKD are associated with poor outcomes and a significant clinical and economic burden.

At present, there are no treatments to cure CKD; as such, strategies for CKD management have been developed to target the modifiable risk factors in order to reduce cardiovascular disease morbidity in patients with CKD and slow the progression of CKD to ESKD. However, despite available treatment options, residual risk of adverse events and CKD progression remain; hence, an unmet need exists in CKD treatment. SGTL2i have the potential to fill this gap, with recent evidence from clinical trials showing a reduction in cardiovascular and renal adverse endpoints in a broad range of patients with CKD.

Acknowledgements

This manuscript was supported by a grant from AstraZeneca UK Ltd. in respect of medical writing and publication costs (the journal’s Rapid Service and Open Access Fees). AstraZeneca has not influenced the content of the publication, and has reviewed this document for factual accuracy only.

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authors’ Contributions

All authors have been involved in design of this review. Marc Evans, Ruth D. Lewis, and Angharad R. Morgan produced the primary manuscript. All authors have contributed to the drafting and revision of the manuscript and have approved the final version for publication. Marc Evans is responsible for the integrity of the work as a whole.

Disclosures

Marc Evans reports honoraria from AstraZeneca, Novo Nordisk, Takeda and NAPP, and research support from Novo Nordisk outside the submitted work. Ruth D. Lewis and Angharad R Morgan are employees of Health Economics and Outcomes Research Ltd., Cardiff, UK who received fees from AstraZeneca in relation to this study. Martin B. Whyte reports investigator-led research grants from Sanofi, Eli Lilly and AstraZeneca and personal fees from AstraZeneca, Boehringer Ingelheim and MSD outside the submitted work. Wasim Hanif reports grants and personal fees from AstraZeneca, grants and personal fees from Boerhinger Inglhiem, grants and personal fees from NAPP, from MSD, outside the submitted work. Stephen C. Bain reports personal fees and other from Abbott, personal fees and other from AstraZeneca, personal fees and other from Boehringer Ingelheim, personal fees and other from Eli Lilly, personal fees and other from Merck Sharp & Dohme, personal fees and other from Novo Nordisk, personal fees and other from Sanofi-aventis, other from Cardiff University, other from Doctors.net, other from Elsevier, other from Onmedica, other from Omnia-Med, other from Medscape, other from All-Wales Medicines Strategy Group, other from National Institute for Health and Care Excellence (NICE) UK, and other from Glycosmedia, outside the submitted work. PAK reports personal fees for lecturing from AstraZeneca, Boehringer Inglhiem, NAPP, MundiPharma and Novo Nordisk outside the submitted work. Sarah Davies has received honorarium from AstraZeneca, Boehringer Ingelheim, Lilly, Novo Nordisk, Takeda, MSD, NAPP, Bayer and Roche for attending and participating in educational events and advisory boards, outside the submitted work. Umesh Dashora reports personal fees from AstraZeneca, NAPP, Sanofi, Boehringer Inglhiem, Lilly and Novo Nordisk, outside the submitted work. Zaheer Yousef reports personal fees from AstraZeneca, personal fees from Lilly, personal fees from Boehringer Ingelheim and personal fees from Novartis outside the submitted work. Dipesh C. Patel reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Eli Lilly, non-financial support from NAPP, personal fees from Novo Nordisk, personal fees from MSD, personal fees and non-financial support from Sanofi outside the submitted work. In addition, DCP is an executive committee member of the Association of British Clinical Diabetologists and member of the CaReMe UK group. W. David Strain holds research grants from Bayer, Novo Nordisk and Novartis and has received speaker honoraria from AstraZeneca, Bayer, Bristol-Myers Squibb, Merck, NAPP, Novartis, Novo Nordisk and Takeda. WDS is supported by the NIHR Exeter Clinical Research Facility and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

15 Ways to Relieve Kidney Pain at Home

by Urology Specialists | Oct 9, 2023

Effective Home Remedies to Relieve Kidney Pain 

Experiencing kidney pain can disrupt your daily life and leave you wondering what to do. If you’re currently experiencing kidney pain, you’re not alone. Millions of people worldwide deal with kidney-related issues, and understanding the causes, symptoms, and management of kidney pain is crucial for your well-being.

While we suggest that anyone who experiences kidney pain visits their urologist, there are several ways to alleviate kidney pain and discomfort from your home. Below, you’ll learn the most common causes of kidney pain and how to treat this type of pain at home. If you or a loved one are experiencing mild to moderate pain in your kidney, this list of home remedies should offer relief .

It’s important to note that while kidney pain is a common symptom of urinary issues, it may be a warning sign of a more serious problem. If kidney pain is recurrent, severe, or accompanied by other symptoms, contact your urologist immediately. 

What Causes Kidney Pain?

Kidney pain can stem from various factors and underlying conditions––and a thorough understanding of the causes of kidney pain is essential for both diagnosis and effective management.   

This section will explore the most common causes of kidney pain. They are: 

• Urinary tract infection (UTI)
• Kidney infection
• Kidney stones
• Bladder infection

Urinary Tract Infection

A urinary tract infection is an infection that occurs in any part of your urinary tract — your kidneys, bladder, ureters, and urethra. The most common symptoms of a UTI are frequent trips to the bathroom, burning sensations when urinating, dark-colored urine, urine that appears to have blood in it , bladder discomfort, and kidney pain.  

Kidney Infection

UTIs can occur in both the lower and upper urinary tract. Infections in the upper urinary tract are kidney infections. The symptoms of a kidney infection include pain in the upper abdomen, fever or chills, nausea, and vomiting.   

Kidney infections can become serious very quickly and are usually the result of an untreated UTI or bladder infection. Contact your urologist if you are experiencing the symptoms of kidney infection.

Kidney Stones

Kidney stones are also extremely common –– so much so that one in 10 people will experience a kidney stone at some point in their life. Kidney stones are hard, mineral-based masses that typically form in the kidneys or urinary tract and cause an immense amount of pain. About 90 percent of stones can be treated to pass through the system independently, but some are too large and will require surgery to remove.   

Kidney stone symptoms are typically severe pain in the back and side and pain that radiates and fluctuates between the lower abdomen and groin. In addition, urination will likely be painful, discolored, and odorous. Kidney stones may also cause nausea and vomiting. 

Bladder Infection

A bladder infection is simply a bacterial infection in the bladder. Bladder infections can also be referred to as urinary tract infections since your bladder is a part of the urinary tract. The symptoms of a bladder infection are pain while urinating, cloudy or bloody urine, frequent urination, foul-smelling urine, and cramping or pain in the lower back or abdomen.   

Pain in the kidneys could also be an indicator of kidney cancer , bleeding in your kidneys, polycystic kidney disease (PKD), or blood clots in your kidneys. It’s important to schedule an appointment with your urologist if pain is persistent or severe, or if you are experiencing the symptoms of a kidney infection. 

6 At-Home Solutions for Kidney Pain from Urinary Tract Infections

Now that we’ve discussed what might be causing your kidney pain, let’s dive into the ways you can alleviate this type of pain at home. Since three of the most common causes of kidney discomfort (UTI, bladder infection, and kidney infection) occur in the urinary tract, here are some remedies to relieve pain in the kidneys related to the urinary tract:

1. Stay Hydrated

Hydration is key to relieving kidney pain since water will help flush bacteria out of the body. Plus, staying hydrated will help clear out the urinary tract as a whole and work to eliminate any possible infections.   

Many specialists recommend the 8×8 rule, meaning you should drink eight 8 oz. glasses of water daily. However, water intake highly depends on you and your health, so consider this article when determining your daily amount of water intake. 

2. Drink Cranberry Juice

While not scientifically proven, cranberry juice is known to be a remedy for urinary tract infections. If you choose to alternate between cranberry juice and water, choose a cranberry juice that isn’t packed full of additional sweeteners. A cranberry supplement or pure cranberry juice is always the best way to go! 

3. Take Probiotics

Probiotics, which are beneficial bacteria that promote gut health, can also positively affect kidney function. Studies suggest that probiotics may enhance kidney function and assist in the processing of waste products in the body. Incorporating probiotic-rich foods like yogurt, kefir, and fermented vegetables into your diet or taking a probiotic supplement can support your kidneys and reduce the risk of kidney-related pain.

4. Drink Parsley Juice

While the thought of drinking parsley juice likely doesn’t sound appealing, it can increase urination and help flush out bacteria. Parsley juice is a nutrient-dense diuretic that can aid in increasing the frequency of urination. You can also mix parsley into a smoothie to make drinking it more bearable. Check out these recipes for inspiration! 

5. Take a Warm Epsom Salt Bath

A warm bath filled with Epsom salts can be a soothing way to alleviate intense kidney pain temporarily. While it may not provide a long-term solution, the warm water and Epsom salts can help relax your muscles and ease discomfort. This can be particularly helpful for individuals experiencing muscle tension or spasms along with kidney pain.

6. Use Non-Aspirin Painkillers

Non-aspirin pain relievers like Ibuprofen (Advil, Motrin) can be effective in reducing kidney pain, especially if it is associated with inflammation. If you have a fever along with kidney discomfort, taking acetaminophen (Tylenol) can help relieve pain and potentially lower your fever. Always follow the recommended dosage guidelines on the medication label and consult with a healthcare professional if you have any concerns or questions about pain relief options.

9 At-Home Solutions for Kidney Stones

While most of the remedies above will help ease kidney stone pain as well, there are more specific solutions for kidney stones. Let’s take a look at some of the specific ways you can alleviate kidney stone pain.

1. Monitor Your Alcohol Consumption

Interestingly enough, alcohol— specifically wine —can be useful for preventing kidney stones and providing pain relief. The antioxidants in wine are beneficial for kidney health, and the extra fluid intake will help flush any stones out of your system as long as they’re passable. 

However, you don’t want to drink too much of it. Do your best to limit your libation intake to 12 ounces of beer or five ounces of wine per day in addition to water. 

2. Add Citrus to Your Water

Lemon juice contains citrate, which is known to prevent calcium stones from forming and breaking apart existing stones. Adding freshly squeezed lemon juice to your water will help work against kidney stones and flush them out of your system. Plus, as we mentioned earlier, staying hydrated by drinking plenty of water will help relieve general kidney discomfort.  

3. Choose Acidic Beverages

Basil, celery, and pomegranate juices are known to fight kidney stones and relieve pain in the kidneys as well. Each contains antioxidants, which will improve your kidney health and flush toxins out of your kidneys. However, these types of juices aren’t for everyone, so we suggest asking your urologist before including any of these juices in your diet.  

4. Drink Apple Cider Vinegar

Apple cider vinegar is sometimes considered a home remedy for kidney stones due to its acetic acid content, which is believed to aid in dissolving certain types of kidney stones, particularly those composed of calcium oxalate. To use apple cider vinegar for this purpose, individuals typically mix two tablespoons of apple cider vinegar into a large glass of water and consume it daily. This remedy is thought to work by gradually breaking down kidney stones. 

5. Drink Hydrangea or Dandelion Root Tea

Herbal teas like hydrangea root and dandelion root are often considered natural remedies for kidney stone management. Hydrangea root tea is believed to support kidney stone passage, with preparation and consumption instructions typically provided on the tea’s packaging. Dandelion root tea, on the other hand, acts as a diuretic, potentially increasing urine production to aid in flushing out stones. To make dandelion root tea, steep dried dandelion root in hot water and consume it regularly. 

6. Add More Watermelon to Your Diet

Watermelon is a refreshing addition to your diet that offers multiple benefits for kidney stone prevention and overall kidney health. With its high water content, watermelon helps maintain proper hydration, which is crucial for diluting urine and reducing the concentration of minerals that can form kidney stones. Additionally, watermelon is rich in potassium, a mineral that may help counteract the formation of certain types of kidney stones, particularly those containing calcium.

7. Eat Kidney Bean Broth

An intriguing home remedy for kidney stone management involves kidney beans and their potential to assist in dissolving stones. According to some beliefs, boiling kidney beans and consuming the resulting broth may contribute to the breakdown of kidney stones. To prepare this remedy, kidney beans are typically boiled until they become soft, and then the liquid is strained and consumed as a broth. 

8. Use a Hot Compress

Applying a warm compress to the lower back or abdomen, specifically targeting the area where kidney pain is concentrated, can help alleviate discomfort. Apply a heating pad to the affected area for approximately 20 minutes at a time to help alleviate discomfort. The warmth from the compress can have a soothing effect, helping to relax the muscles surrounding the urinary tract and ease tension in the muscles surrounding the kidneys while also helping improve blood flow to the area.

9. Moderate Your Calcium Intake

Reducing excessive calcium intake can play a vital role in the prevention of certain types of kidney stones. While calcium is an essential mineral for overall health, an overabundance of dietary calcium can increase the risk of developing calcium oxalate stones, one of the most common types of kidney stones. Therefore, it’s essential to strike a balance in your calcium consumption to support your overall health and kidney stone prevention. 

Not All Kidney Pain is Treatable With At-Home Remedies

While these solutions may help relieve, or in some cases eliminate, mild kidney pain, they will not stop infections from spreading. When left untreated, even the occasional UTI can turn into something more severe, which is why it’s always in your best interest to contact your urologist when you are experiencing any type of pain in your kidneys. 

Based on your symptoms, an in-office visit may not be required. Talk to your urologist and ask questions about the type of pain you are experiencing. They can tell you if at-home remedies are possible or if you need to schedule an appointment .

As always, feel free to contact us with any questions you may have. And don’t forget to download our Nutrition & Lifestyle Guide before you go for more health and wellness tips from our urological experts!

Access The Guide

This post was originally written in September 2019 and rewritten in October 2023.

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Acute kidney injury (aki), table of contents, about acute kidney injury (aki), signs and symptoms, complications, preparing for your appointment.

Acute kidney injury (AKI) is the sudden loss of kidney function. Learn more about the symptoms to watch for and ways to lower your risk.

Acute kidney injury (AKI) is a term used to describe when your kidneys are suddenly not able to filter waste products from the blood. This can happen within a few hours or a few days. For most people, AKI develops within 48 hours, but sometimes it can take as long as 7 days.

This replaces an older term “acute renal failure” (or ARF) which you may still see or hear occasionally.

The signs and symptoms of AKI can differ depending on many factors like the cause, severity, and your other health conditions. If symptoms do happen, they may include one or more of the following:

• Making less urine (pee) than usual or no urine
• Swelling in legs, ankles, and/or feet
• Fatigue or tiredness
• Shortness of breath (trouble breathing)
• Confusion or mood changes
• High blood pressure
• Decreased appetite (low desire to eat)
• Flank pain (pain on the side of your back - between your ribs and hips)
• Chest pain or pressure
• Seizures or coma (in severe cases)

In some cases, AKI causes no symptoms and is only found through other tests done by your healthcare professional.

AKI can have many different causes. Many people get AKI when a related disease or condition puts extra stress on your kidneys. Another common cause for AKI is when your body is reacting to an urgent or emergent health concern (such as heart surgery or COVID-19 infection). Lastly, AKI can be caused by medications or other substances that you may consume. Examples for each of these scenarios are provided below.

Usually, AKI happens because of a combination of factors. This is especially true for older adults who are at higher risk given their age.

Related disease or condition

• Autoimmune kidney disease, such as glomerulonephritis , lupus , or IgA nephropathy
• Cancer (especially bladder, cervical, ovarian, or prostate cancer)
• Chronic kidney disease
• Diabetes flare-up (also known as diabetes-related ketoacidosis or DKA)
• Heart disease (e.g. heart attack, heart failure, or other condition leading to decreased heart function)
• Kidney infection
• Kidney stones
• Liver disease or cirrhosis
• Multiple myeloma (a specific type of blood cancer)
• Vasculitis (long-term inflammation and scarring in your blood vessels)

Urgent or emergent health concerns

• Acute tubular necrosis (ATN), a situation causing very low blood flow to the kidneys
• Anaphylaxis (severe allergic reaction)
• Blood clot or cholesterol blocking a blood vessel in your kidney(s)
• Hypotension (very low blood pressure) or shock
• Hemorrhage (severe loss of blood)
• Major surgery
• Pregnancy complications
• Severe dehydration (not getting enough water or fluids for your body’s needs)
• Severe diarrhea and/or vomiting
• Severe skin burns

Medications and other substances

Items in this list may not cause AKI by themselves, but when combined with other factors from the other 2 categories above, your risk of AKI goes up significantly.

• Certain antibiotics, especially ones given for severe infections
• Certain blood pressure medicines, like ACE inhibitors/ARBs or diuretics (water pills)
• ibuprofen (Motrin, Advil)
• indomethacin (Indocin)
• naproxen (Aleve, Naprosyn)
• diclofenac tablets or capsules (Cataflam, Zipsor)
• celecoxib (Celebrex)
• meloxicam (Mobic)
• aspirin (only if more than 325 mg per day)
• Iodine-based contrast dye (used for CT scans and other forms of medical imaging)
• Recreational drugs, such as heroin or cocaine
• Some medicines used for cancer or HIV
• Toxic alcohols, such as methanol, ethylene glycol (antifreeze), or isopropyl/isopropanol (rubbing alcohol)

AKI can cause a build-up of waste products in your blood and make it hard to keep the right balance of fluid and minerals in your body. It can also cause permanent damage to your kidneys, leading to chronic kidney disease (CKD) . Without treatment, AKI can also affect other organs such as the brain, heart, and lungs. So, it is important to know what to watch for and how to lower your risk.

If your healthcare professional suspects AKI, they will perform an assessment to identify its potential cause (or causes). This may include performing a physical exam, reviewing your medical conditions and medication use history in the past week (including over-the-counter products and herbal supplements), asking about recent events and experiences (e.g. symptoms, water intake, recreational drug use, relevant travel), and ordering blood and/or urine tests.

Some of the most common tests used to check for AKI, include:

• Serum (blood) creatinine – a blood test used to check how well your kidneys are filtering this waste product from your blood
• Estimated glomerular filtration rate (eGFR) – this is calculated based on your serum (blood) creatinine level, age, and sex to estimate your kidney function
• Blood urea nitrogen (BUN) – similar to creatinine, this test can be used to measure another waste product in your blood to see how well your kidneys are filtering the blood
• Other blood tests , such as sodium, potassium, and bicarbonate (to see if anything is out of balance)
• Urine output – your healthcare professional may track how much urine (pee) you pass each day, especially if you are having AKI in the hospital
• Urine test (urinalysis) – a general urine test may be used to find more clues about the cause of AKI
• Imaging tests , like an ultrasound, may be helpful in some cases
• Kidney biopsy – in some less common situations, your healthcare professional may need to look at a tiny piece of your kidney under a microscope to get a better idea about the cause

Other tests may be ordered based on what your healthcare professional thinks might be causing your AKI.

Treatment for AKI depends on what caused it in the first place. This is why finding the cause is so important. Some most common approaches to treating AKI include:

• Stopping any medicines that may be causing or contributing to your AKI
• Giving you fluids (either by mouth or through your veins)
• Antibiotics (if AKI is caused by a bacterial infection)
• Placing a urine catheter (a thin tube used to drain your bladder, useful if AKI is caused by a blockage)
• In most cases, dialysis treatments are only temporary until the kidneys can recover.

Most people with AKI will need to spend some time in the hospital to be monitored while receiving treatment.

After having AKI, you have a higher risk for other health problems, such as chronic kidney disease (CKD), heart disease, or stroke). You are also at a higher risk of getting AKI again in the future. So, it is important to have regular follow-up visits with your healthcare professional and check your kidney health, starting with two simple tests (ideally within 3 months of finishing treatment for your AKI).

Questions to ask

• What are my biggest risk factors for AKI?
• What can I do to help lower my risk for AKI?
• Are there any medications I should avoid (either now or in the future) due to my kidneys?
• [If having potential symptoms of AKI] Should I go to the emergency room for my symptoms?
• Was the cause of my AKI preventable? If so, what can I do to prevent it from happening again?
• When should I follow up after my AKI treatment is done to check my kidney health?

This content is provided for informational use only and is not intended as medical advice or as a substitute for the medical advice of a healthcare professional.

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How to Relieve Kidney Pain

Last Updated: April 15, 2024 Approved

This article was medically reviewed by Victor Catania, MD . Dr. Catania is a board certified Family Medicine Physician in Pennsylvania. He received his MD from the Medical University of the Americas in 2012 and completed his residency in Family Medicine at the Robert Packer Hospital. He is a member of the American Board of Family Medicine. There are 15 references cited in this article, which can be found at the bottom of the page. wikiHow marks an article as reader-approved once it receives enough positive feedback. This article received 20 testimonials and 90% of readers who voted found it helpful, earning it our reader-approved status. This article has been viewed 326,258 times.

Research suggests that if you experience pain in your back between your ribs and your buttocks, or even down your sides into your groin area, you may be having kidney pain. [1] X Research source Although back pain is not always caused by your kidneys, you should talk to your doctor to make sure you don't have any serious medical conditions. Experts note that treating your kidney pain will depend on its cause, and your doctor can make the best recommendations for your situation. [2] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source

Relieving Kidney Pain

• A small kidney stone (<4mm) may also be passed spontaneously with urine if the flow is adequate.
• Limit your intake of coffee, tea, and cola to one to two cups per day. [5] X Research source

• Lying on your side could aggravate your kidney pain.

• Do not apply too much heat, as this could cause burns. Use a heating pad, soak in a hot bath, or use a cloth that’s been soaked in hot (but not boiling) water.

• Do not take high-dose aspirin. Aspirin can increase the risk of bleeding and can worsen any vascular obstruction, like a kidney stone.
• NSAIDs can be dangerous if you have decreased kidney function. Do not take ibuprofen or naproxen if you already have a kidney condition, unless it's recommended by your doctor. [9] X Research source

• Common antibiotics used in this type of infection are Trimethoprim, Nitrofurantoin, Ciprofloxacin, and Cefalexin. In mild to moderate infection, men should be treated for 10 days while women should be treated for three days.
• Always take the full course of antibiotics prescribed to you, even if you begin to feel better and your symptoms disappear.

• People who are prone to developing calcium oxalate stones should limit their consumption of oxalate-rich foods such as beets, chocolate, coffee, cola, nuts, parsley, peanuts, rhubarb, spinach, strawberries, tea, and wheat bran.

• Avoid cranberry juice if you have an oxalate stone, as it contains significant amounts of vitamin C and is high in oxalates.

Knowing What Causes Kidney Pain

• Fever, possibly with chills
• Frequent urination
• A strong and persistent urge to urinate
• Burning or pain while urinating
• Pus or blood in the urine (may be red or brownish)
• Foul-smelling or cloudy urine
• Seek emergency medical attention if you have these symptoms combined with nausea and vomiting

• Kidney stones often manifest in sudden, extreme pain in the lower back, side, groin, or abdomen. [12] X Research source
• Kidney stones may also cause other symptoms, including pain in the penis or testicles, difficulty urinating, or a frequent, urgent need to urinate. [13] X Research source

• Abdominal pain or swelling
• Blood in the urine
• Drowsiness or sleepiness
• Decreased urination or difficulty urinating
• Increased heart rate
• Nausea and vomiting
• Cool, clammy skin

Expert Q&A

• “Natural” remedies such as dandelion, apple cider vinegar, rose hips, and asparagus are not supported by science as helpful treatments for kidney stones. Stick to drinking plenty of water and see your doctor for other options. [16] X Research source [17] X Research source Thanks Helpful 0 Not Helpful 0
• Stay hydrated. It is important to flush out any bacteria in your kidney by drinking lots of water. Thanks Helpful 5 Not Helpful 0

• If you are experiencing kidney pain, talk to a doctor right away. Thanks Helpful 52 Not Helpful 11

You Might Also Like

• ↑ https://www.kidneyfund.org/kidney-disease/kidney-problems/kidney-pain.html
• ↑ https://my.clevelandclinic.org/health/symptoms/17688-kidney-pain
• ↑ https://www.kidney.org/content/6-tips-be-water-wise-healthy-kidneys
• ↑ https://www.medicinenet.com/cystinuria/page2.htm
• ↑ https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000135.htm
• ↑ https://www.nhs.uk/Conditions/Kidney-infection/Pages/Treatment.aspx
• ↑ https://www.nlm.nih.gov/medlineplus/ency/article/001065.htm
• ↑ https://www.hopkinsmedicine.org/health/conditions-and-diseases/analgesic-nephropathy
• ↑ https://www.kidney.org/atoz/content/painMeds_Analgesics
• ↑ https://www.medicinenet.com/kidney_pain/page5.htm#how_is_kidney_pain_treated
• ↑ https://www.kidneyfund.org/all-about-kidneys/other-kidney-problems/kidney-stones
• ↑ https://www.healthdirect.gov.au/kidney-pain
• ↑ https://www.kidney.org/atoz/content/kidneystones
• ↑ https://www.nlm.nih.gov/medlineplus/ency/article/003113.htm
• ↑ https://www.kidney.org/atoz/content/diet

About This Article

Medical Disclaimer

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

Read More...

Before you try to treat your kidney pain, visit your doctor for a diagnosis of the problem, since it may be something more serious. In addition to what your doctor says, you can take simple steps at home to reduce your kidney pain. Drink plenty of water and other fluids, which can help flush out your kidneys. Make sure to include cranberry juice as a daily drink, since it stops bacteria growing in your kidneys. You should also try to get plenty of rest, since lots of movement can cause bleeding if you have a kidney injury. While you rest, apply a hot pad or warm cloth for temporary pain relief. Heat helps blood flow and reduces the sensitivity of your nerves, making the pain more bearable. If natural pain relief methods don’t work, take paracetamol or another over-the counter painkiller. If you think you have abdominal pain, see blood in your urine, or experience an increased heart rate, seek emergency medical attention. For tips from our Medical co-author on how to tell if you've injured your kidney, keep reading. Did this summary help you? Yes No

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• Acute kidney failure

Kidney cross section

The kidneys remove waste and extra fluid from the blood through filtering units called nephrons. Each nephron contains a filter, called a glomerulus. Each filter has tiny blood vessels called capillaries. When blood flows into a glomerulus, tiny bits, called molecules, of water, minerals and nutrients, and wastes pass through the capillary walls. Large molecules, such as proteins and red blood cells, do not. The part that's filtered then passes into another part of the nephron called the tubule. The water, nutrients and minerals the body needs are sent back to the bloodstream. The extra water and waste become urine that flows to the bladder.

Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your blood's chemical makeup may get out of balance.

Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly, usually in less than a few days. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.

Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you're otherwise in good health, you may recover normal or nearly normal kidney function.

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Signs and symptoms of acute kidney failure may include:

• Decreased urine output, although occasionally urine output remains normal
• Fluid retention, causing swelling in your legs, ankles or feet
• Shortness of breath
• Irregular heartbeat
• Chest pain or pressure
• Seizures or coma in severe cases

Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.

When to see a doctor

See your doctor immediately or seek emergency care if you have signs or symptoms of acute kidney failure.

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Acute kidney failure can occur when:

• You have a condition that slows blood flow to your kidneys
• You experience direct damage to your kidneys
• Your kidneys' urine drainage tubes (ureters) become blocked and wastes can't leave your body through your urine

Impaired blood flow to the kidneys

Diseases and conditions that may slow blood flow to the kidneys and lead to kidney injury include:

• Blood or fluid loss
• Blood pressure medications
• Heart attack
• Heart disease
• Liver failure
• Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others) or related drugs
• Severe allergic reaction (anaphylaxis)
• Severe burns
• Severe dehydration

Damage to the kidneys

These diseases, conditions and agents may damage the kidneys and lead to acute kidney failure:

• Blood clots in the veins and arteries in and around the kidneys
• Cholesterol deposits that block blood flow in the kidneys
• Glomerulonephritis (gloe-mer-u-loe-nuh-FRY-tis), inflammation of the tiny filters in the kidneys (glomeruli)
• Hemolytic uremic syndrome, a condition that results from premature destruction of red blood cells
• Infection, such as with the virus that causes coronavirus disease 2019 (COVID-19)
• Lupus, an immune system disorder causing glomerulonephritis
• Medications, such as certain chemotherapy drugs, antibiotics and dyes used during imaging tests
• Scleroderma, a group of rare diseases affecting the skin and connective tissues
• Thrombotic thrombocytopenic purpura, a rare blood disorder
• Toxins, such as alcohol, heavy metals and cocaine
• Muscle tissue breakdown (rhabdomyolysis) that leads to kidney damage caused by toxins from muscle tissue destruction
• Breakdown of tumor cells (tumor lysis syndrome), which leads to the release of toxins that can cause kidney injury

Urine blockage in the kidneys

Diseases and conditions that block the passage of urine out of the body (urinary obstructions) and can lead to acute kidney injury include:

• Bladder cancer
• Blood clots in the urinary tract
• Cervical cancer
• Colon cancer
• Enlarged prostate
• Kidney stones
• Nerve damage involving the nerves that control the bladder
• Prostate cancer

Risk factors

Acute kidney failure almost always occurs in connection with another medical condition or event. Conditions that can increase your risk of acute kidney failure include:

• Being hospitalized, especially for a serious condition that requires intensive care
• Advanced age
• Blockages in the blood vessels in your arms or legs (peripheral artery disease)
• High blood pressure
• Heart failure
• Kidney diseases
• Liver diseases
• Certain cancers and their treatments

Complications

Potential complications of acute kidney failure include:

• Fluid buildup. Acute kidney failure may lead to a buildup of fluid in your lungs, which can cause shortness of breath.
• Chest pain. If the lining that covers your heart (pericardium) becomes inflamed, you may experience chest pain.
• Muscle weakness. When your body's fluids and electrolytes — your body's blood chemistry — are out of balance, muscle weakness can result.
• Permanent kidney damage. Occasionally, acute kidney failure causes permanent loss of kidney function, or end-stage renal disease. People with end-stage renal disease require either permanent dialysis — a mechanical filtration process used to remove toxins and wastes from the body — or a kidney transplant to survive.
• Death. Acute kidney failure can lead to loss of kidney function and, ultimately, death.

Acute kidney failure is often difficult to predict or prevent. But you may reduce your risk by taking care of your kidneys. Try to:

• Pay attention to labels when taking over-the-counter (OTC) pain medications. Follow the instructions for OTC pain medications, such as aspirin, acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others). Taking too much of these medications may increase your risk of kidney injury. This is especially true if you have pre-existing kidney disease, diabetes or high blood pressure.
• Work with your doctor to manage kidney and other chronic conditions. If you have kidney disease or another condition that increases your risk of acute kidney failure, such as diabetes or high blood pressure, stay on track with treatment goals and follow your doctor's recommendations to manage your condition.
• Make a healthy lifestyle a priority. Be active; eat a sensible, balanced diet; and drink alcohol only in moderation — if at all.
• Ferri FF. Acute kidney injury. In: Ferri's Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed July 16, 2020.
• Goldman L, et al., eds. Acute kidney injury. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed July 16, 2020.
• Acute kidney injury. American Kidney Fund. http://www.kidneyfund.org/kidney-disease/kidney-problems/acute-kidney-injury.html. Accessed May 15, 2018.
• Acute kidney injury. The Merck Manual Professional Edition. https://www.merckmanuals.com/professional/genitourinary-disorders/acute-kidney-injury/acute-kidney-injury-aki. Accessed May 15, 2018.
• Negi S, et al. Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies. Seminars in Dialysis. 2018; doi: 10.1111/sdi.12705.
• Kidney-friendly diet for CKD. American Kidney Fund. http://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/kidney-friendly-diet-for-ckd.html. Accessed May 15, 2018.
• Palevsky PM, et al. Coronavirus disease 2019 (COVID-19): Issues related to kidney disease and hypertension. https://www.uptodate.com/contents/search. Accessed July 16, 2020.

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Guest Essay

Let People Sell Their Kidneys. It Will Save Lives.

By Dylan Walsh

Mr. Walsh is a freelance journalist who focuses on science and the criminal justice system.

I owe the past 25 years of my life to my father, who dozed under general anesthesia as a surgeon cut eight inches from stomach to spine, removed one of his kidneys, placed it on ice and sent it to a nearby operating room, where it was fitted into my abdomen. My brother had a kidney transplant the same week, six days before I did. His new kidney came from a man we never knew who had died in a car accident in the mountains.

We were teenagers, afflicted with a congenital kidney disease. But we were lucky.

There are 100,000 people in the United States waiting for a kidney. More than half a million are on dialysis, which from my experience I know to be more of a means of survival than a form of living. About 4,000 people die each year while waiting for a kidney. Another 4,000 become too sick to undergo surgery — a gentler way of saying that they, too, die. The National Kidney Foundation estimates that without more investment in preventing diabetes and other ailments, more than one million people will be suffering from kidney failure by 2030, up from over 800,000 now .

These numbers illuminate a story of largely preventable suffering. Hundreds of millions of healthy people walk the streets quietly carrying two kidneys. They need only one. The head-scratcher is how to get kidneys from the people who have one to spare into the people who need one. Getting them from genetically modified pigs , as was recently found possible, won’t be a widespread solution for a very long time.

There’s a simpler and long overdue answer: Pay people for their kidneys.

Creating a market for kidneys is not a new concept, but it’s historically been met with disgust: Sell what? To be fair, some of the ways to structure such a market would be irresponsible, coercive and deserving of that disgust.

But others are more thoughtful and prudent. One approach is to make the federal government the sole purchaser of kidneys. Donor and recipient would never meet. Compensation would be fixed, haggling impossible. After the kidney is acquired, the transplant process would unfold in the typical manner.

This idea fits nicely within today’s health economics. Through a quirk of a 50-year-old law , Medicare is the primary insurer for anyone of any age in need of dialysis or a transplant. This has extended the lives of hundreds of thousands of people. It has also been costly, with end-stage renal disease patients accounting for about 7 percent of Medicare’s spending, despite constituting 1 percent of its users. Because transplants are ultimately cheaper than dialysis, if Medicare started paying people to donate kidneys, fewer people would need to survive on dialysis, and Medicare would need less taxpayer money to cover it.

Federal law presents the first and most significant hurdle to a market for kidneys. The 1984 National Organ Transplant Act, NOTA for short, makes it unlawful “to knowingly acquire, receive or otherwise transfer any human organ for valuable consideration for use in human transplantation.” Though markets exist for human tissue, bone, amniotic stem cells and blood plasma and for the use of a woman’s womb and her eggs, organs cannot legally be bought and sold.

For several decades, efforts to persuade people to become kidney donors haven’t increased the number of volunteers. There were roughly 6,000 living kidney donors in 2000; there were roughly 6,000 in 2023. The only way to get more donors is to change the law.

One organization, the Coalition to Modify NOTA, hopes to legalize compensation and then pass a federal law it has titled the End Kidney Deaths Act . As it’s written, it would award living donors $50,000 over five years — $10,000 per year — through refundable tax credits. The coalition says it has held meetings with nearly 100 legislators from both parties and has been encouraged by the level of support for its idea (though the bill still has not been brought to the floor of Congress).

Other proposals meant to solve kidney donation shortages abound. Several bills have recently been introduced to Congress, including one that would prohibit life and disability insurance companies from denying coverage to or increasing premiums for donors, and another that would reimburse donors for expenses they incur during donation. Two Colorado state representatives, one Democratic and one Republican, have drafted their own proposal for a statewide tax credit of up to $40,000 for organ donors; a representative in New Hampshire is trying to create an open market for organs in his state.

Some people who are opposed to the idea of selling organs argue that we should instead improve the process of capturing organs from people who have died. But even a flawlessly functioning system that recovered and transplanted 100 percent of available organs would not meet demand. And deceased-donor kidneys don’t last as long as those from living donors.

One of the most consistent and vociferous objections to a kidney market centers on the fear of coercion or exploitation: If you pay people to do something, particularly if you pay them a lot, then you will drive those who are most desperate and socially precarious to take steps they later will regret.

Ned Brooks, a co-founder of the Coalition to Modify NOTA, told me there are ways to mitigate “the concern that someone is going to donate a kidney because they have a gambling debt or they are losing their house to foreclosure or you name it.” His organization’s proposal, for example, would split the $50,000 payment into installments arriving only around tax season to weaken donation as a get-rich-quick scheme. Even now, donation requires a weeks- to monthslong process of physical and psychological evaluation .

Compensating donors could also go a long way to reducing current inequities. Black patients are more than three times as likely to develop kidney failure as white patients. And under today’s system, white patients are about four times as likely as Black patients (and approximately two times as likely as Asian and Hispanic patients) to receive a living kidney donation within two years of needing one . While there are many reasons for this imbalance, one critical factor is that white people generally possess social networks saturated with volunteers who are able to make the kinds of accommodations needed for major surgery. Compensation would broaden the pool of available kidneys for those who lack these social networks.

Alongside the flurry of political activity surrounding organ donation, a shift in attitudes among the public seems to be underway, making this moment particularly ripe for legislative change. A 2019 study found that roughly 60 percent of Americans would favor compensation through a public agency — and this number, depending on the form of compensation, would increase to 70 percent to 80 percent if such a system eliminated kidney shortages. This is a rare nonpartisan idea at a highly polarized moment and could save the dozen people who die every day waiting for a kidney.

My kidney has been ticking along since August 1998, far longer than the average transplantation. It will give out sometime, maybe before my children graduate from high school. It will almost certainly fail before any children they may have are born. Still, I’ve lived 25 years I would not have had otherwise. I hope for a world in which others — many others — are given such an exquisite gift.

Dylan Walsh is a freelance journalist in Chicago who focuses on science and the criminal justice system.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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8 Painful Experiences That Are Equivalent to Giving Birth

There's no denying childbirth can be painful, but some other things are on par with the discomfort level.

There's one thing almost every pregnant person believes to be true: Childbirth is the worst pain you could ever feel. But some other types of pain are equivalent to childbirth pain. In fact, some people who have experienced both would even say they hurt more .

And while everyone experiences childbirth pain differently, it doesn't have to be feared. It's certainly uncomfortable, but there are ways to manage the discomfort and make it more tolerable. Plus, you have the reward of a tiny baby to look forward to at the finish line!

Below, discover which types of pain are on par with childbirth pain. We also explore factors that could make delivery more challenging, and what you can do to mitigate the discomfort you're experiencing.

Broken Bones

Breaking a bone is painful. While not all broken bones are the same, some—like a compound fracture of a femur—will knock you off your feet for some time. In addition to requiring a large cast , compound fractures may also necessitate surgery to place hardware, like pins and screws, into your body.

The location of the break and how you use that part of your body will also determine the pain level. A broken rib might ache every time you take a breath, whereas a pinky-finger fracture might be fairly well stabilized and not as painful once it's in a splint or cast.

Some broken bones require months of treatment and years of residual pain. Childbirth, on the other hand, only lasts several hours. Even very long labor  rarely lasts more than a weekend!

Related: We Asked Real Parents: What Does Giving Birth Feel Like?

Certain Headaches

Headaches can be severe, especially beyond the typical ones where you pop an over-the-counter pain pill and continue your day. Migraine headaches are significant sources of pain, and they can last for hours or days with debilitating symptoms like:

• Light sensitivity
• Visual disturbances

Many people with migraines wind up taking prescription pain medication to both prevent and treat their symptoms.

For others, cluster headaches are even worse than migraines. Extreme pain around the eye socket can last for hours and reoccur daily. People have described cluster headaches as feeling as though you're giving birth through your eyeball, but without the prize of a baby when you're done.

Related: Your Guide to Treating Headaches During Pregnancy

Kidney Stones

Kidney stones form in your urinary tract and have to be passed. This means that the stone, either whole or broken into bits, will need to come out. Kidney stones usually travel through the urinary tract and exit the body via the urethra. Some stones even require surgery. Symptoms of kidney stones can include:

• Constant urge to urinate

Some people who've experienced both kidney stones and childbirth say passing a stone is worse than childbirth. After all, the body isn't designed to pass kidney stones, but it's made to birth a baby .

Gallstones are small stones in the gallbladder that can cause quite a bit of pain. While medications and nutritional guidelines can help manage them, gallstones can plague you for a long time or come in waves of attacks. These attacks frequently include symptoms like:

• Unremitting pain

In severe cases, surgery may be needed to remove the gallbladder itself. Some people who've had gallstones and given birth say gallstones were much worse.

Bladder Infections and Urinary Tract Infections (UTI)

Bladder infections and urinary tract infections (UTI) can cause a lot of pain. Sometimes people can even get these infections during pregnancy . Here are some of the common symptoms:

• Frequent urge to urinate
• Back pain or lower abdomen and sides
• Blood in urine

Root Canals

Many people compare the pain of childbirth to the pain of dental work. A root canal, for example, is an uncomfortable procedure, during which a hole is drilled inside the tooth and the nerve underneath the tooth is removed from the root. A filling is used to patch the tooth back up, and the pain stops because the nerve has been removed.

The pain of a root canal starts before the procedure with a toothache. While the discomfort stops once the root is removed, there's usually residual soreness.

The aftermath of the root canal can affect your activities for a couple of days, make it difficult to eat, and requiring pain medication. People who've needed a root canal say it's worse than childbirth.

Surgery is obviously painful, though some procedures are more involved than others. Cutting tissue, muscles, or organs, or moving internal structures to access the part of the body that needs operating, will leave a person in pain for days and weeks afterward.

Heart surgery, for example, requires the sternum to be cracked and removed to get to the heart. The pain from this can last for weeks, and maybe months, often requiring therapy to help manage.

Surgeries that involve the use of laparoscopy are less painful than surgeries where a larger incision is made. Pain level is also affected by the type of surgery, the location of the incision, and the health of the individual. Needless to say, recovery from surgery can be more painful than childbirth.

Induced Labor

It would be remiss not to mention that  induced labor  is a source of pain that can be potentially worse than your standard spontaneous labor. This is because your body is quickly thrown into labor using medicine, rather than experiencing labor through a slow build-up.

Factors That Affect Pain During Childbirth

While a handful of experiences might hurt worse than labor, the significance of the pain caused by giving birth shouldn't be minimized. Here are a few factors that can affect your discomfort during labor and delivery.

Fear or anxiety during childbirth can increase pain. Anxiety can cause muscles to tense and constrict blood flow. Adrenaline is also released, which makes it difficult to relax. Consider breathing exercises , relaxing music, calming scents, or a partner massage to help you reduce anxiety and relax through the birthing process.

Birthing position

Some birthing positions may cause more discomfort than others. Lying on your back, for example, typically makes your baby press more toward your spine than your pelvis, prolonging the labor and contributing to pain. Meanwhile, standing, squatting , and other vertical positions allow gravity to assist by putting pressure on the cervical opening and helping your baby to pass through.

Fetal position

Ideally, babies will be head down and facing your back during labor. This position is the most comfortable and efficient for delivery. However, not all babies rotate completely before the onset of labor, and your baby's position in the womb could cause more pain.

For instance, if your baby is head down but facing your belly, called posterior positioning (or sunny side up) this could increase discomfort. Likewise, if your baby's buttocks are positioned first in the birth canal, called breech presentation , you may experience more pain.

Methods for Coping With Childbirth Pain

Here's the good news: Certain techniques can help you cope with pain during labor. There aren’t any wrong or right choices, just personal ones. Methods include:

• Distraction
• Epidural anesthesia
• IV medications
• Massage and therapeutic touch

Remember, you can learn valuable pain-coping techniques during childbirth class—which is more than what exists for broken bones. It can also be helpful to exercise consistently to help prepare your body for labor.

Key Takeaway

If you're worried about childbirth pain, it's important to reframe your thinking so that you're not overcome by fear or anxiety. Remind yourself that the pain experienced in labor is only temporary, typically does not last for days, and is intermittent. Labor also is more predictable than a gallstone or kidney stone, and the outcome is usually much happier.

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