04. tbl. 97. árg. 2011
Acute flank pain syndrome: a common presentation of acute renal failure in young men in Iceland
Brátt síðuheilkenni: algeng birtingarmynd bráðrar nýrnabilunar hjá ungum mönnum á Íslandi
Objectives: The purpose of the study was to calculate the incidence of the acute flank pain syndrome in Iceland and to describe the case series.
Material and methods: The hospital records of those who fulfilled the following criteria were studied: age 18-41 years, acute renal failure, and a visit to Landspitali University Hospital in 1998-2007. The acute flank pain syndrome was defined as severe flank pain in combination with acute renal failure, unexplained except for the possible consumption of NSAIDs, ethanol or both. Information was collected about the sales of NSAIDs.
Results: One hundred and six patients had acute renal failure. Of those, 21 had the acute flank pain syndrome (20%). The annual incidence of the acute flank pain syndrome increased threefold during the study period. The average incidence was 3.2/100.000/year (relative to the population of the Reykjavik area) and 2.0/100.000/year (relative to the population of Iceland). 18 patients were male and the median age was 26 (19-35) years. The symptoms regressed spontaneously during a few days or weeks. There was history of NSAID intake in 15, ethanol consumption in 15, either in 20, and both in nine patients. The sales figures of NSAIDs were high and they increased during the study period, especially those of the over-the-counter sales of ibuprofen.
Conclusions: The incidence of the acute flank pain syndrome was high. The paper describes the largest case series that has been published since the withdrawal of suprofen in 1987. Young people should be warned about consuming NSAIDs during or directly after binge drinking.
Skuladottir HM, Andresdottir MB, Hardarson S, Arnadottir M.
Acute flank pain syndrome: a common presentation of acute renal failure in young men in Iceland.
Icel Med J 2011; 97: 215-20
Correspondence: Margrét Árnadóttir,margarn@landspitali.is
Key words: acute renal failure, binge drinking, flank pain, nonsteroidal antiinflammatory drugs
Figure legend
Figure 1. The incidence of the acute flank pain syndrome during the period 1998-2007 relative to the population of the Reykjavík area (number of cases/100.000 inhabitants/year).
Table I. The demographic data and history of the patients who sought the emergency room at Landspítali University Hospital because of the acute flank pain syndrome. F = female, M = male, NSAID = nonsteroidal antiinflammatory drug(s). Gaps indicate missing information.
no. year age (years) sex ethanol type of NSAID indication for NSAID
1 1998 35 M unknown
2 1998 35 M yes diclofenac hangover
3 2000 33 M unknown back pain
4 2001 22 M yes
5 2003 27 M ibuprofen
6 2003 30 M ibuprofen respiratory infection
7 2004 35 M yes unknown hangover
8 2004 28 F yes ibuprofen hangover
9 2005 29 M yes
10 2005 25 M yes
11 2005 30 M yes ibuprofen myalgia
12 2005 32 M yes ibuprofen hangover
13 2006 19 F
14 2006 23 M diclofenac postoperative pain
15 2006 34 M yes ibuprofen+diclofenac injury
16 2007 23 M yes ibuprofen periostitis
17 2007 18 M yes
18 2007 26 M yes ibuprofen+diclofenac injury
19 2007 23 M yes
20 2007 26 F yes ibuprofen hangover
21 2007 19 M yes ibuprofen hangover
Table II. The symptoms and signs of the patients who sought the emergency room at Landspítali University Hospital because of the acute flank pain syndrome. Gaps indicate missing information.
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no. location of pain nausea painful percussion blood pressure (mm Hg)
1 flanks 140/70
2 flanks+abdomen + + 124/77
3 flanks+abdomen + + 140/90
4 flanks+abdomen + + 145/80
5 flanks + + 127/75
6 flanks+abdomen + + 140/75
7 flank+abdomen + + 125/71
8 flank+abdomen + 134/91
9 flank+abdomen + + 160/86
10 flank 140/65
11 flank+abdomen + + 159/83
12 abdomen + + 148/90
13 flanks + + 134/72
14 abdomen + 150/58
15 flanks + + 130/80
16 flanks + + 150/80
17 flanks+abdomen + 132/72
18 flanks + + 154/100
19 flank+abdomen + 110/70
20 abdomen 160/98
21 flanks + + 128/72
