Causes of right flank pain

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Vendhan Ramanujam M.B.B.S [2]

Overview

Right flank pain is a sensation of discomfort, distress or agony in the right side of the abdomen below the rib and above the ilium, generally beginning posteriorly or in the midaxillary line. It usually arises from the right kidney, its capsule or right ureter. But similar pain is sometimes caused by extraurinary abnormalities.

Causes

Life Threatening Causes

• Acute tubular necrosis
• Ischemic colitis
• Ovarian torsion
• Renal abscess
• Renal artery dissection
• Renal cyst rupture or hemorrhage
• Ruptured abdominal aortic aneurysm

Common Causes

• Abdominal muscle spasm
• Acute pyelonephritis
• Nephrolithiasis
• Polycystic kidney disease
• Renal cyst
• Urinary tract infection

Causes by Organ System

Cardiovascular	Acute cortical necrosis, acute tubular necrosis, arteriovenous malformation, atheroemboli, fibromuscular dysplasia, hypertensive emergency, hypertensive urgency, ischemic colitis, renal artery aneurysm, renal artery dissection, renal infarction, renal vein thrombosis, ruptured abdominal aortic aneurysm, thromboemboli
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Herpes zoster
Drug Side Effect	Acute papillary necrosis, crystal induced acute kidney injury, drug induced interstitial nephritis
Ear Nose Throat	No underlying causes
Endocrine	Adrenal hemorrhage, adrenocortical carcinoma
Environmental	No underlying causes
Gastroenterologic	Acute cholecystitis, appendicitis during pregnancy, ascending colon carcinoma, biliary colic, cholangitis, cholelithiasis, colitis, colon carcinoma, echinococcosis, gall stones, gallbladder empyema, hepatitis, hepatomegaly, inflammatory bowel disease, ischemic colitis, liver abscess
Genetic	Xanthine oxydase deficiency
Hematologic	Acute papillary necrosis, sickle cell disease, coagulopathy
Iatrogenic	Infected penile prosthesis, nephrostomy, pelvic surgery
Infectious Disease	Acute nephritis, acute pyelonephritis, adrenal hemorrhage, bilharziosis, candidemia, cholangitis, colitis, echinococcosis, emphysematous pyelitis, fungal bezoars, fungemia, fungus balls, herpes zoster, liver abscess, pelvic inflammatory disease, perinephric abscess, poststreptococcal glomerulonephritis, psoas abscess, renal abscess, renal mucormycosis, renal zygomycosis, urinary tract infection, urosepsis, urogenital tuberculosis
Musculoskeletal/Orthopedic	Abdominal muscle spasm, abdominal muscle strain, abdominal muscle tear, disc disease, referred pain from back, spinal arthritis
Neurologic	Neuralgia, neurogenic bladder
Nutritional/Metabolic	Acute uric acid nephropathy, xanthine oxidase deficiency
Obstetric/Gynecologic	Adnexitis, ectopic pregnancy, endometriosis, outwards pressure on the ribs from the growing uterus, ovarian cyst, ovarian torsion, ovarian tumor, pelvic inflammatory disease, pelvic surgery, polyembryoma, stretching of tissues around the uterus
Oncologic	Adrenocortical carcinoma, angiomyolipoma, ascending colon carcinoma, bladder carcinoma, collecting duct carcinoma, colon carcinoma, oncocytoma, ovarian tumor, polyembryoma, renal cell carcinoma, transitional cell carcinoma, Wilms tumor
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Somatoform disorder
Pulmonary	No underlying causes
Renal/Electrolyte	Acute cortical necrosis, acute kidney injury, acute nephritis, acute papillary necrosis, acute pyelonephritis, acute tubular necrosis, acute uric acid nephropathy, Alport's syndrome, angiomyolipoma, bladder carcinoma, calix diverticulum, collecting duct carcinoma, crystal induced acute kidney injury, drug induced interstitial nephritis, ectopic ureter, emphysematous pyelitis, fibromuscular dysplasia, glomerulonephritis, hydronephrosis, hypercalciuria, IgA nephropathy, Infected penile prosthesis, loin pain hematuria syndrome, malakoplakia, megaureter, nephrolithiasis, nephroptosis, nephrostomy, neurogenic bladder, obstructive uropathy, paroxysmal nocturnal haemoglobinuria, perinephric abscess, polycystic kidney disease, post renal transplantation, posterior urethral valves, poststreptococcal glomerulonephritis, reflux nephropathy, renal abscess, renal artery aneurysm, renal artery dissection, renal cell carcinoma, renal cyst, renal cyst infection, renal cyst rupture or hemorrhage, renal dystopia, renal infarction, Renal mucormycosis, renal papillary necrosis, renal trauma, renal vein thrombosis, renal zygmycosis, thin basement membrane nephropathy, transitional cell carcinoma, tubulointerstitial nephritis, ureteropelvic junction obstruction, urinary tract infection, urogenital tuberculosis, urolithiasis, urosepsis, Wilms' tumor
Rheumatology/Immunology/Allergy	Acute nephritis, Alport's syndrome, Ormond's disease, paroxysmal nocturnal haemoglobinuria, post renal transplantation, poststreptococcal glomerulonephritis
Sexual	No underlying causes
Trauma	Abdominal muscle strain, abdominal muscle tear, perforation of a viscus, renal trauma
Urologic	No underlying causes
Miscellaneous	Exercise, lymphangioma, multifocal fibrosclerosis, retroperitoneal fibrosis, retroperitoneal hematoma, tuberous sclerosis

Causes in Alphabetical Order

• Abdominal muscle spasm
• Abdominal muscle strain
• Abdominal muscle tear
• Acute cholecystitis
• Acute cortical necrosis
• Acute kidney injury
• Acute nephritis
• Acute papillary necrosis
• Acute pyelonephritis
• Acute tubular necrosis
• Acute uric acid nephropathy
• Adnexitis
• Adrenal hemorrhage
• Adrenocortical carcinoma
• Alport's syndrome
• Angiomyolipoma
• appendicitis during pregnancy
• Arteriovenous malformation
• Ascending colon carcinoma
• Atheroemboli
• Bilharziosis
• Biliary colic
• Bladder carcinoma
• Calix diverticulum
• Candidemia
• Cholangitis
• Cholelithiasis
• Coagulopathy
• Colitis
• Collecting duct carcinoma
• Colon carcinoma
• Crystal induced acute kidney injury
• Disc disease
• Drug induced interstitial nephritis
• Echinococcosis
• Ectopic pregnancy
• Ectopic ureter
• Emphysematous pyelitis
• Endometriosis
• Exercise
• Fibromuscular dysplasia

• Fungal bezoars
• Fungemia
• Fungus balls
• Gall stones
• Gallbladder empyema
• Glomerulonephritis
• Hepatitis
• Hepatomegaly
• Herpes zoster
• Hydronephrosis
• Hypercalciuria
• Hypertensive emergency
• Hypertensive urgency
• IgA nephropathy
• Infected penile prosthesis
• Inflammatory bowel disease
• Ischemic colitis
• Liver abscess
• Loin pain hematuria syndrome
• Lymphangioma
• Malakoplakia
• Megaureter
• Multifocal fibrosclerosis
• Nephrolithiasis
• Nephroptosis
• Nephrostomy
• Neuralgia
• Neurogenic bladder
• Obstructive uropathy
• Oncocytoma
• Ormond's disease
• Outwards pressure on the ribs from the growing uterus
• Ovarian cyst
• Ovarian torsion
• Ovarian tumor
• Paroxysmal nocturnal haemoglobinuria
• Pelvic inflammatory disease
• Pelvic surgery
• Perforation of a viscus
• Perinephric abscess
• Polycystic kidney disease

• Polyembryoma
• Post renal transplantation
• Posterior urethral valves
• Poststreptococcal glomerulonephritis
• Psoas abscess
• Referred pain from back
• Reflux nephropathy
• Renal abscess
• Renal artery aneurysm
• Renal artery dissection
• Renal cell carcinoma
• Renal cyst
• Renal cyst infection
• Renal cyst rupture or hemorrhage
• Renal dystopia
• Renal infarction
• Renal mucormycosis
• Renal papillary necrosis
• Renal trauma
• Renal vein thrombosis
• Renal zygmycosis
• Retroperitoneal fibrosis
• Retroperitoneal hematoma
• Ruptured abdominal aortic aneurysm
• Sickle cell disease
• Somatoform disorder
• Spinal arthritis
• Stretching of tissues around the uterus
• Thin basement membrane nephropathy
• Thromboemboli
• Transitional cell carcinoma
• Tuberous sclerosis
• Tubulointerstitial nephritis
• Ureteropelvic junction obstruction
• Urinary tract infection
• Urogenital tuberculosis
• Urolithiasis
• Urosepsis
• Vesicoureteral reflux
• Wilms' tumor
• Xanthine oxidase deficiency