Vitamin D Deficiency as a Cause of Flank Pain

Abstract

Introduction: Loin pain is a relatively common complaint seen in a variety of clinical settings. Many of these cases seek medical advice of urologists and nephrologists based on the impression that this pain originates from the urinary tract. In spite of the importance of diseases of the urinary tract as causes of loin pain, many of the patients presenting with this complaint are devoid of any urinary abnormalities. Methods: Differential diagnosis includes musculoskeletal, respiratory, gastrointestinal, neurologic and cutaneous causes. In this work, we present a series of 187 cases presenting to our center with loin pain that did not prove a renal cause. Results: During physical examination of these cases, tenderness over the lowermost ribs above the flank at the posterior and mid axillary lines was eminent. Within the laboratory and radiologic work-up performed to these cases, very low serum level of 25 (OH) vitamin D was a constant feature. Vitamin D replacement was associated with complete relief of the pain in most of these cases. Conclusion: The presence of tenderness over the costal margin rather than the renal angle proper should alert examining physician to the possibility of disease in the ribs. After exclusion of trauma as a cause of this pain and tenderness, estimation of vitamin D level is a mandate.