Difficult case! I will assume that his stool is negative for occult blood,
ESR is normal, has no deceleration in his growth velocity and is otherwise a
well adjusted boy. Given his hydronephrosis and intermittent hematuria, I
believe that his pain may indeed be nephrogenic in origin. As you stated, he
may be experiencing dynamic obstruction of his UPJ.
I would suggest doing a provocative test like a "Lasix Renal Scan." If
induction of diuresis causes a relative obstruction with reproduction of his
pain you have made the diagnosis.
Other thoughts include Celiac disease. Anti-gliadin antibodies and an
intestinal biopsy might be helpful to make the diagnosis.
Keep us posted.
Jay Pershad, MD
Pediatric Emergency Specialists, PC
LeBonheur Children's Medical Center
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: