Do autoimmune flare-ups result in kidney pain and damage?

Question

Hi doctor,

I am having an unidentified autoimmune flare, and my kidneys have been aching for a couple of months. It seems to be more consistent and sometimes wraps around the front. I have confirmed that I have no stones or infections through an X-ray and urgent care visit. I had my GFR tested a couple of months ago. It was 70. I am having continued pain on a daily basis. I had no protein in my urine. I am concerned about permanent kidney damage. I had an autoimmune flare about five years ago. Sjögren’s was somewhat of a diagnosis but was not confirmed. I am only taking Lisinopril once a day. I have had a pretty big workup in the last two months from a functional medicine doctor.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com

I have read your query and understand your concern.

Kidney pain during an autoimmune flare can be concerning, especially with your history and ongoing symptoms. Here are some points to consider and suggestions for your next steps:

What might be causing the kidney pain?

Autoimmune-related kidney involvement: Diseases like Sjogren’s syndrome, lupus, or other autoimmune conditions can affect the kidneys (for example, interstitial nephritis and glomerulonephritis) even without stones or infections.

Medication side effects: Lisinopril is generally kidney-protective, but can sometimes cause issues if kidney function is compromised.

Musculoskeletal causes: Sometimes, flank or back pain can mimic kidney pain but arise from muscles, nerves, or the spine.

Other kidney issues: Though stones and infections are ruled out, conditions like renal artery stenosis, chronic kidney disease progression, or other rare causes might still be at play.

Your laboratory values and their meaning:

Glomerular filtration rate (GFR) of 70: This indicates a mild reduction in kidney function (normal is generally more than 90), but it is still relatively preserved.

No proteinuria: Good sign that there is no overt kidney inflammation or severe damage currently.

Continued pain: Needs thorough evaluation since pain is persistent.

What you should do next:

See a nephrologist: A kidney specialist can evaluate your symptoms, review your labs, and possibly order additional tests such as:

Urine microscopy and 24-hour urine collection.
Kidney ultrasound or more detailed imaging (for example, magnetic resonance imaging).
Autoimmune panel (antinuclear antibody ANA, anti-Sjögren's syndrome-related antigen A and B, anti-SSA/SSB, dsDNA, complement levels).
Kidney biopsy if indicated.
Review medications: Ensure no other medications or supplements could be affecting your kidneys.
Pain management: Discuss safe pain control options, as some common painkillers can worsen kidney function.
Hydration and lifestyle: Maintain good hydration but avoid excess salt and nephrotoxic substances (nonsteroidal anti-inflammatory drugs, certain antibiotics).
Monitor kidney function: Regular follow-up (GFR, creatinine, urine tests) to track any progression.

When to seek urgent care:

Sudden worsening of pain.
New symptoms like swelling, foamy urine, and high blood pressure spikes.
Signs of infection or severe illness.

Hope this answers your query.

Thank you.