YANAD/YANMD – Was I mis-diagnosed?
April 26, 2011 6:59 AM   Subscribe

Last Thursday and Friday I had really bad pain in my back on the right side, in the middle – just about where the ribcage ends. I had a low-grade fever on Friday evening. On Saturday morning I decided that the pain was bad enough to necessitate a trip to an Urgent Care facility, as my doctor does not have weekend hours.

I advised the staff that the ONLY symptoms I had were the severe back pain and the low-grade fever (that was only present Friday evening). They did not take an x-ray or ultrasound – nor did they even TOUCH my back. They took a urine sample and came back in a bit and diagnosed me with a UTI that had apparently affected my kidney. I have/had no other symptoms of a UTI – no burning, no unproductive frequency – nothing. Doesn't it seem like a UTI that got so bad that it traveled up to the kidney would have produced some other symptoms? They gave me a prescription for 500 mg of Cipro twice daily. I called this morning to get the results of the culture and was told that they did not find any “unusual bacteria”. I still have the pain in my back; it is a TINY bit less severe than it was initially. Any thoughts? Thanks! :)
posted by sleepykitties to Health & Fitness (11 answers total)
I have about given up on my local urgent care because I always end up having to follow up with my doctor anyway. They seem generally unwilling to diagnose, so I end up being told my allergies are just acting up when I really have a sinus infection, for instance. Or being told recently that I just needed to give antibiotics "more time to work" when I ended up needing a round of steroids. So I have a tendency to be cranky about urgent care, though certainly others' experiences may differ.

If you've been on the antibiotics for 48 hours and haven't seen improvement, I'd take that as a sign that it's time to follow up with your doctor. My experience is that getting on the correct antibiotics for an infection leads to miraculous-feeling reduction in symptoms within 24 hours.

When I had pain like yours--severe back pain in that spot--it turned out to be gallstones. FWIW.
posted by not that girl at 7:08 AM on April 26, 2011

Severe lower back pain and high fever were a kidney infection for me.
posted by L'Estrange Fruit at 7:29 AM on April 26, 2011

FWIW, it is possible to have a kidney stone without having an infection. (I've been hospitalized twice for "complicated" kidney stones because I had an accompanying infection - without infection they tend to send you home with heavy drugs and wait for you to pass it.) That pain in that location definitely sounds as if it could be a kidney stone - get back in to your own doc.
posted by Daily Alice at 7:36 AM on April 26, 2011

Yeah, I once had an awful kidney infection that I had to be hospitalized for--and never had any symptoms of a UTI at all.
posted by leesh at 7:36 AM on April 26, 2011

Response by poster: Thanks for chiming in everyone :)
I called my Doctor's office and after explaining the entire situation they want me to finish the course of antibiotics (will be done Friday) and call them on Monday if it still hurts. It kind of stinks, because I am fairly convinced that I didn't/don't have a UTI and both Urgent Care and now my Doctor's office seem fairly convinced that I do. Ugh. I guess it looks like I'll be waiting it out 'til Monday :(
posted by sleepykitties at 8:00 AM on April 26, 2011

I had the symptoms you describe and was found to have a kidney stone blocking the flow of urine into the bladder. Do you have chills with your fever? According to my doctor (who diagnosed me over the phone correctly, vs all the yahoos at the ER who took ten hours to get it right), chills with fever are nearly always a sign of a kidney stone or other more severe kidney issue.
posted by anastasiav at 8:01 AM on April 26, 2011

Best answer: sleepykitties, it is definitely possible and it sounds like you are getting the right initial treatment to me.

This happens frequently - most people who are getting very uncomfortable UTI symptoms will get treatment before the infection extends to the kidneys. Thus, it is usually people who do not get uncomfortable UTI symptoms, or who for some other reason have delayed treating their UTI who end up with kidney infections.

Your urinalysis must have been abnormal and showed signs of infection - if it had been normal, they would have looked for other causes of the pain and fever. The symptoms you describe are very typical of a kidney infection, so unless you develop other symptoms, there is no need to look for other possible causes.

anastasiav, I take issue with your doctor's assertion, unless he stated it differently. Chills with a fever can happen with any infection, including pyelopnephritis, and don't specify anything about the cause.
posted by treehorn+bunny at 8:27 AM on April 26, 2011 [1 favorite]

Best answer: I've had 3 pretty severe kidney infections in my life and am very easily susceptible to UTIs. The 2nd kidney infection I had presented as: vomiting, severe pain in my back and side, and a fever that started low and increased over 2 days. I had ZERO UTI symptoms and I certainly was no stranger to UTIs and had already suffered through a horrible kidney infection that started as a UTI that I couldn't treat properly as I was in the middle of a cross country road trip. The reason I ended up in Urgent Care with this 2nd one was because I was concerned about appendicitis - never considered it could be a UTI or kidney infection based on my prior experiences.

My point is, kidney infections in my experience do not always present in the same manner (nor do UTIs which can sometimes be asymptomatic). Trust your doctors, finish your antibiotics, and I hope you feel better soon!
posted by katy song at 12:01 PM on April 26, 2011

I've had a bad kidney infection from a UTI that I didn't know I had and I'm no stranger to UTIs so it's entirely possible.

They did not take an x-ray or ultrasound

You had pretty typical kidney infection symptoms and peeing in a cup confirmed that. An x-ray or an ultrasound is overkill in this situation. That might have been the next step if your urine came back fine.
posted by MaryDellamorte at 3:31 PM on April 26, 2011

I think you should be seen again if you're essentially no better after 3-4 days of antibiotics. Two possibilities that come to mind:

-a false negative culture but urinary bug resistant to Cipro
-urine sample test initially falsely positive or over-interpreted, and you actually have something else, potentially dangerous (fever with back pain is a 'red flag')
posted by kevinsp8 at 11:55 PM on April 26, 2011

Oh, and consider a real emerg instead of either urgent care or office.
posted by kevinsp8 at 11:55 PM on April 26, 2011

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