An Address ON ACHES AND PAINS OF RENAL ORIGIN
Authors: A. Fullerton
Journal: BMJ (1923)

EVERY practitioner is confronted from time to time with the proble"mnof'aclies and pains which raise a suspicion of some disorder of tte kidney, and my intention in this address is to record my own difficulties in diagnosis, and the methods adopted to su'rm`otunt -them.I have Zone carefully through the recor,ds of upwards of 1,500 successive cases of cystoscopy, of which I-have notes, and picked out those in which pain was complained of, with a view to ascertain; whether the condition of the liidney or ureter or the site of tlle lesion could be correlated with pain of a particular type or distribution.The results of these observations show, on the one hand, that the-most extensive disease of the kidney may exist without any pain whatever, and,' on the other, that a very slig4t departure from the norm.almay be associated with almost unbearable agony; also that a precisely similar condition may, in ,one pati,ent, give rise to the merest local dis- comfort, and in another to pain of a severe character, radiating to the utmost terminations of 1he1.peripheralnerves.I have in my mind at th'e moment a man who used to bring in a small bottle a nu,mberr'of' small calculi passed with the minimnum of discomforts Any one. of these small calculi would be capable in' anoter' patient of producing the most intense.renalcolic.Papin and Ambard in a recent articlel give some interesting facts bearing on renal pain anda,its treatment,' which will be referred to later.It will be e'onvenient at this stage to review briefly the nerve supply of the kidney' and its pelvis, based on Papin axLdAxrpbard's account.. The-lki4ney' dd?t nerve supply through the renal plexus which accompanies the great vessels into the hilum.Branches also accompany the vessels to the capsule 1.That due to mechanical or traumatic causes.2. That due to inflammatory conditions.The mechanical causes are:A. Distension of the ureter,.pelvis,and calices.B. Distension of the parencbyina in the capsule by congestion or oedema of the kidney.. C. Contact of a foreign-body witlh the walls of the pelvis or calices.D. Dragging of the pedicle of the kcidney.E. Compression of nerves.Most of the pain is, however, reflex or of a toxic nature.F. Sclerosis of the kidney.The inflammatory causes are:A. Lesions of the pelvis and ealices, such as pyonephrosis.B. Lesions of the parenchyma, such as pyelonephritis.C. Lesions of the perirenal cellular tissue, such as perine£hritis and perinephritic abscess.These authors are of opinion that renal pain is usually, as a matter of fact, pyelic.In calculus, lhydronephrosis, mnovable kidney, renal tuberculosis, cancer, and renal haematuria, obstruction of the ureter declares itself by renal colic due to distension of the pelvis.Pain in the kidney iiself is generally of moderate intensity except in inflammatory lesions, when it may become very severe.it is very instructive, when one is constantly seeina cases of urinary disease, to record in the patient's own words ,his description of the pain he suffers.A collection of such accounts is of great interest, especially if tIe case is followed to its termination by operation or in the po8t-rnortem room.A study on these lines shows that the most varied pathological c.onditions may give rise to almost identical symptoms.-This supports the suggestion that a common cause may be present in