Perinephritis is an inflammation of the tissue around one or both kidneys, and it usually happens because an infection has spread from the urinary tract or kidney. Early symptoms of perinephritis can include fever, pain in the side or back, feeling unwell, and sometimes pain with urination or nausea. It can affect adults of any age, but it is more likely in people with kidney infections, urinary blockage, kidney stones, or a weakened immune system. Not everyone will have the same experience. Perinephritis often improves with antibiotics and treatment of the underlying cause, but severe or untreated cases can become life-threatening if infection spreads or an abscess forms.
How many people live with Perinephritis?
Perinephritis is not routinely tracked as its own condition in major global or U.S. health statistics, so there is no reliable recent estimate of how many people live with it worldwide or in the United States. This is partly because it is usually recorded under broader kidney or urinary tract infections, or as a complication seen in hospital care, rather than counted as a separate long-term condition.
Overview
PerinephritisSymptoms
Perinephritis often causes pain in the side or lower back, fever, chills, and tenderness near the kidney. Some people also have painful urination, nausea, or feel generally unwell.
Outlook and prognosis
With prompt treatment, perinephritis often improves within days, and many people recover fully. Outlook is less favorable if infection spreads, an abscess forms, or treatment is delayed, which can raise the risk of kidney damage and sepsis.
Causes and risk factors
Perinephritis usually develops when a kidney or urinary infection spreads into nearby tissue. Risk rises with kidney stones or other urinary blockage, diabetes, catheter use, and a weakened immune system. Rarely, injury or nearby infection can also trigger it.
Genetic influences
Genetics are not thought to play a major role in perinephritis. Most cases are linked to infection, blockage, injury, or nearby inflammation rather than inherited genetic variations.
Diagnosis
Perinephritis is diagnosed with a physical exam, urine and blood tests, and imaging such as ultrasound or CT scans. Doctors also look for the cause, such as infection, blockage, or a nearby abscess.
Treatment and drugs
Perinephritis is treated by controlling the infection and easing pain. Many people need antibiotics, and if pus has collected around the kidney, drainage may be needed. Severe cases often need hospital care, fluids, and close monitoring.
Symptoms
Pain along one side of the back or upper belly, fever, and a strong sense of feeling unwell are common ways perinephritis can show up. The early symptoms of perinephritis can look a lot like a kidney or urinary infection, so the problem is not always obvious at first. Symptoms vary from person to person and can change over time.
Perinephritis often causes pain in the side of the back, just below the ribs. It may feel like a deep ache or a sharper pain that gets worse with movement, coughing, or a bumpy car ride.
Fever is common, and many people also have chills or sweating as the body reacts to infection or inflammation. Some may feel shaky, flushed, or suddenly much worse over a short time.
The pain can spread toward the upper abdomen, lower belly, or groin instead of staying in one small area. This can make it seem like a stomach problem at first.
The painful side may feel unusually sore when you lie on it, bend, or press near it. Even simple movements like getting out of a chair can become uncomfortable.
How people usually first notice Perinephritis?
People usually first notice perinephritis when a deep, steady pain develops in the side or back near one kidney, often along with fever, chills, and feeling generally unwell. Many with perinephritis also notice urinary symptoms such as pain or burning with urination, needing to go more often, or urine that looks cloudy, which can make it seem at first like a routine urinary tract infection that is getting worse instead of better. Because the first signs of perinephritis can overlap with a kidney infection, doctors usually become more concerned when flank pain, fever, and tenderness over the kidney area appear together.
Types of Perinephritis
Perinephritis can feel quite different depending on whether the inflammation comes on quickly or builds over time. In practice, doctors usually think about types of perinephritis based on how suddenly symptoms start and how long the problem lasts. Symptoms don’t always look the same for everyone. Acute forms tend to cause more noticeable illness, while chronic forms may be quieter but more persistent.
Acute perinephritis
This type starts suddenly and often causes flank or back pain, fever, chills, and a general sick feeling. Many living with acute perinephritis may also notice pain with movement or tenderness over the area near one kidney. Symptoms usually develop over hours to days and often need prompt medical attention.
Chronic perinephritis
This type develops more slowly and may cause ongoing dull discomfort in the side or back rather than sharp pain. Some may find that tiredness, low-grade fever, or repeated urinary problems are more noticeable than severe pain. In chronic perinephritis, symptoms can be easier to miss because they often come and go or build gradually.
Can I slow down the onset of symptoms?
Not really in a reliable way: there is no strong evidence that lifestyle changes can meaningfully delay the start of symptoms of perinephritis, because it usually happens when an infection or irritation develops around the kidney. What may help lower the risk, but not prevent it, is getting bladder or kidney infections treated early, drinking enough fluids, managing problems like diabetes, and getting quick care for kidney stones or any blockage of urine flow. If you are at higher risk, early medical care for fever, back or side pain, or burning with urination is the most important step, and while this cannot promise prevention, it can sometimes stop a mild problem from becoming more serious.
What genetics can tell you about symptoms
For perinephritis, genetics usually do not tell doctors much about which symptoms will happen, how severe they will be, or when they will start. Symptoms such as fever, pain in the side or back, and feeling unwell are driven mainly by the underlying infection or inflammation around the kidney and how quickly it is treated. In rare cases, an inherited condition that affects the urinary tract or immune system may raise the chance of kidney-related infections, but it does not create a clear, well-established genetic symptom pattern for perinephritis itself.
Causes and risk factors
Perinephritis usually starts when a bacterial infection from the bladder or kidney spreads into the tissue around the kidney. Kidney stones, blocked urine flow, urinary catheters, and recent urinary procedures are common risk factors for perinephritis. Diabetes, a weakened immune system, and nearby infections or injury can also make it more likely. It is not usually inherited, but some risks can run in families, such as a tendency to form stones or develop diabetes. Knowing the risks can help you feel more in control, and delaying care for UTI symptoms can raise the chance of the infection spreading.
What are the most common causes or risk factors?
Perinephritis most often happens when a kidney or urinary tract infection spreads into the tissue around the kidney. The main things that raise the risk are kidney stones, a blockage that slows urine flow, repeated urine infections, recent urinary tract procedures or injury, and health problems such as diabetes or a weakened immune system. There is no well-known inherited or genetic cause.
Environmental and biological risk factors
Perinephritis usually happens when an infection spreads into the tissue around the kidney rather than staying limited to the urine or the kidney itself. Doctors often group risks into internal (biological) and external (environmental). Knowing the main risk factors for perinephritis can help explain why some urinary infections spread deeper and need urgent care.
An untreated or severe kidney infection can break through into the tissue around the kidney. This is one of the main risk factors for perinephritis.
Kidney stones, scarring, tumors, or prostate enlargement can slow or block urine flow. When urine backs up, bacteria can multiply more easily and infection is more likely to spread beyond the kidney.
Pregnancy, reflux of urine, birth differences in the urinary tract, or bladder nerves that do not empty well can lead to repeated infections. Over time, these biological factors can raise the chance of perinephritis.
Diabetes and conditions or medicines that weaken the immune system make it harder for the body to clear bacteria. High blood sugar or reduced immune defenses can allow a urinary infection to become deeper and more serious.
Genetic risk factors
Perinephritis is usually not caused by one specific inherited gene. Instead, most genetic risk factors for perinephritis are inherited conditions that make urine flow problems or kidney infections more likely, which can allow inflammation to spread into the tissue around the kidney. Carrying a genetic change doesn’t guarantee the condition will appear. A family history of reflux, kidney infections, stones, or inherited kidney disorders can be an important clue.
Family history: A family history of repeated kidney infections, urine reflux, or kidney tract problems can point to a higher inherited risk. It does not mean perinephritis will happen, but it can help explain why some families have more serious urinary infections.
Urine reflux: Vesicoureteral reflux is a condition that often runs in families and lets urine flow backward from the bladder toward the kidneys. This can raise the chance of kidney infection, and in severe cases infection may spread around the kidney.
Urinary tract changes: Some people are born with kidney, ureter, or bladder differences that can run in families. When urine does not drain normally, infections are easier to develop and may become more complicated.
Polycystic kidneys: Polycystic kidney disease is an inherited condition that causes many fluid-filled sacs to grow in the kidneys. These changes can make infection more likely in some people and may increase the risk of deeper kidney-related inflammation.
Inherited stone disorders: Some inherited conditions, such as cystinuria, can lead to repeated kidney stones. Stones can block urine flow, which makes infection more likely and can set the stage for perinephritis.
Immune disorders: Rare inherited immune system disorders can make it harder for the body to clear bacterial infections. This can increase the chance of severe urinary or kidney infections that spread beyond the kidney itself.
Lifestyle risk factors
Several everyday habits can increase the chance of kidney-area infections or make inflammation around the kidney harder to control. For people asking about lifestyle risk factors for perinephritis, the most relevant factors are those that promote urinary tract infections, delay treatment, or strain immune and kidney health. Habits that support hydration, prompt care, and overall metabolic health may help lower the risk of worsening infection and complications.
Not drinking enough fluids can reduce urine flow and make it easier for bacteria to remain in the urinary tract. This can increase the chance that infection spreads upward and contributes to inflammation around the kidney.
Regularly holding urine for long periods can encourage bacterial growth in the bladder. This raises the risk of urinary tract infection, which can progress and contribute to perinephritis if not addressed.
Inadequate genital hygiene or wiping in a way that moves bacteria toward the urethra can increase urinary infection risk. Repeated urinary infections make kidney-related complications more likely.
Sexual activity without good hygiene practices or adequate post-intercourse urination can increase the risk of urinary tract infections in some people. More frequent infections can create more opportunities for kidney-area spread.
Risk prevention
Perinephritis is usually not something people can prevent directly, because it often develops when a urinary tract or kidney infection spreads into the tissues around the kidney. In day-to-day life, prevention mostly means lowering the chance of serious urine infections and treating them early before they travel upward. Prevention works best when combined with regular check-ups.
Burning with urination, fever, or new back pain should be checked promptly so a bladder infection does not move up to the kidneys. Early treatment of a urinary tract infection can lower the risk of perinephritis.
Drinking enough fluid helps keep urine flowing and may lower the chance of some urinary infections. For many, this can mean aiming for pale yellow urine unless a doctor has told you to limit fluids.
Kidney stones, an enlarged prostate, or other blockages can trap urine and make infection more likely. Treating these problems can reduce the risk that infection spreads and leads to perinephritis.
Diabetes and other illnesses that affect the immune system can make severe kidney-area infections more likely. Good blood sugar control and regular medical care may help lower that risk.
Can you prevent Perinephritis?
Perinephritis, which is inflammation or infection in the tissue around the kidney, cannot always be prevented. The best-known ways to lower the risk are to get treatment early for urinary tract infections and kidney infections, and to manage problems that can block urine flow, such as kidney stones, as well as health conditions like diabetes. These steps can reduce risk, but they do not guarantee that the condition will not happen.
Transmission
Perinephritis is usually not something you catch from another person. It most often happens when bacteria already inside the body, often from a urinary tract infection that has moved up to the kidney or from an infection traveling through the bloodstream, spread into the tissue around the kidney.
That means casual contact, kissing, sharing food, or being near someone with Perinephritis does not usually pass it on. In short, how Perinephritis spreads is very different from illnesses like the flu: it is generally considered noncontagious, even though the infection causing it can still be serious and needs prompt treatment.
When to test your genes
Perinephritis is usually an acquired infection or inflammation around the kidney, not a genetic condition, so genetic testing is not part of early detection or routine care. What matters more is prompt medical evaluation if you have fever, flank pain, urinary symptoms, or repeated kidney infections, because imaging, urine tests, and blood tests guide diagnosis and treatment.
Diagnosis
Perinephritis is usually suspected when pain near the side or back, fever, and feeling unwell suggest an infection or inflammation around the kidney. Doctors usually begin by looking at symptoms, examining the abdomen and back, and checking for signs that the infection may involve nearby tissues rather than just the urinary tract. Because several kidney and abdominal problems can look similar, how perinephritis is diagnosed often involves a mix of lab tests and imaging.
Doctors ask about flank pain, fever, chills, urinary symptoms, recent urinary tract infection, kidney stones, or recent procedures. A detailed family and health history can help, but perinephritis is usually diagnosed from the current illness rather than an inherited pattern.
The clinician checks for tenderness over the side or back, fever, fast heart rate, and signs of dehydration or severe infection. This helps show how sick someone is and whether urgent treatment is needed.
A urine sample is checked for white blood cells, bacteria, blood, and other signs of infection. Urine culture can help identify the germ and guide antibiotic treatment, although the urine can sometimes be less informative if the infection is mainly around the kidney.
Blood tests often look for raised inflammation markers, changes in white blood cell count, and kidney function. Blood cultures may also be taken if there is fever or concern that the infection has entered the bloodstream.
How is Perinephritis diagnosed?
Perinephritis, which means inflammation or infection in the tissue around a kidney, is usually diagnosed by asking about symptoms like fever, pain in the side or back, and urinary problems, followed by a physical exam and urine and blood tests to look for signs of infection. Doctors often use imaging tests such as an ultrasound or CT scan to see whether the area around the kidney is swollen or whether there is a pocket of infection. There is no genetic test for perinephritis, because the diagnosis mainly depends on symptoms, exam findings, lab results, and scans.
Stages of Perinephritis
Perinephritis does not have defined progression stages. This is because it is usually an acute problem linked to inflammation or infection around the kidney, rather than a condition that moves through clear step-by-step phases over time. Doctors usually start with a conversation about symptoms such as fever, side or back pain, and feeling generally unwell, including any early symptoms of perinephritis that may have come on quickly. Diagnosis and follow-up often rely on an exam, urine and blood tests, and imaging such as ultrasound or CT scans to check for inflammation, infection, or a pocket of pus around the kidney.
Outlook and prognosis
With prompt diagnosis and appropriate antibiotics, the outlook for perinephritis is usually good, and most people recover without lasting kidney damage. Prognosis depends on how quickly the infection is treated, the severity of inflammation or any abscess formation, and whether there are contributing problems such as urinary obstruction, kidney stones, diabetes, or immunosuppression. If treatment is delayed, the infection can extend into the kidney or bloodstream, leading to sepsis, which significantly worsens outcomes. Some patients need drainage of a perinephric abscess or surgery in addition to antibiotics, and recovery may be longer in these cases. Mortality is uncommon with timely modern treatment but can occur in severe, untreated, or complicated infections, especially in frail or medically vulnerable patients. Long-term prognosis is generally favorable once the underlying source of infection is identified and corrected.
Long-term effects
Perinephritis can leave lasting problems when inflammation around the kidney is severe, returns, or is treated late. For many, symptoms settle fully, but some may go on to have pain, repeated infections, or reduced kidney function. It’s important to remember that long-term doesn’t always mean progressive. Understanding long-term patterns can guide treatment choices.
Ongoing pain in the side, back, or upper abdomen can happen if inflammation leaves scar tissue around the kidney. Some people notice this most with bending, lifting, or after another urinary infection.
Healing after severe inflammation may leave bands of scar tissue or adhesions around nearby structures. In some cases, this can contribute to discomfort or make future infections harder to clear completely.
Perinephritis may raise the chance of getting kidney or urinary tract infections again, especially if the original cause is still present. Early symptoms of perinephritis or a new urinary infection, such as fever, side pain, or painful urination, should be checked promptly.
If the inflammation also injures the kidney itself, some people can be left with reduced kidney function. This is more likely after a large abscess, delayed treatment, or repeated infections affecting the same kidney.
How is it to live with Perinephritis?
Living with perinephritis often means dealing with deep pain in the side or back, fever, fatigue, and a general sense that your body is under strain, which can make work, sleep, exercise, and even routine errands much harder. Because this condition usually needs prompt medical care and close follow-up, daily life may suddenly revolve around rest, medications, tests, and watching for warning signs such as worsening pain or chills. For family and other people nearby, the effect is often practical as well as emotional: they may need to help with transportation, meals, childcare, or simply provide support while the person living with perinephritis recovers.
Treatment and drugs
Perinephritis is treated by dealing with the cause of the inflammation around the kidney, which is often a bacterial infection, so many people need antibiotics and close follow-up. If the infection is severe, you may need hospital care for antibiotics given through a vein, fluids, pain relief, and monitoring, especially if you have fever, chills, vomiting, or feel weak. Doctors sometimes recommend a combination of lifestyle changes and drugs, but in perinephritis that usually also means fixing anything that is blocking urine flow, such as a kidney stone, and draining any pocket of pus if one has formed. Finding the right therapy can take some time, because treatment depends on how serious the infection is, what germ is causing it, and whether there is kidney damage or another urinary problem that needs care.
Can you cure Perinephritis?
Sometimes, yes, perinephritis can be cured, especially when it is caused by an infection and treated quickly. Treatment usually focuses on clearing the infection with antibiotics, and some people also need a procedure to drain trapped fluid or treat the cause, such as a blockage. The sooner it is treated, the better the chance of full recovery and of avoiding lasting kidney damage.
Non-drug treatment
Perinephritis can make everyday life feel exhausting, with flank pain, fever, and trouble staying comfortable through the day. Treatment usually centers on medical care for the cause, but non-drug steps can still help support recovery and reduce strain on the kidneys. Alongside medicines, non-drug therapies often include rest, fluids, comfort measures, and close follow-up. If there is a pocket of infection or a blockage, a procedure may be needed rather than home care alone.
Rest gives your body more energy to fight infection and recover. Many living with perinephritis may need to scale back work, exercise, and heavy lifting for a time.
Drinking enough water can help prevent dehydration, especially if fever or sweating is part of the illness. Your care team may suggest limits if you have heart failure, kidney failure, or trouble passing urine.
Gentle heat on the side or back can ease muscle tension and make flank pain feel less sharp. Use a warm, not hot, pack for short periods to avoid skin burns.
Small, simple meals can be easier to manage when pain or nausea lowers your appetite. It is natural to wonder if lifestyle changes really matter, but steady fluids and regular food can help support healing.
Your genes may have an impact on how drugs work for you
For people with perinephritis, treatment often includes antibiotics and pain medicine, and inherited differences can affect how fast the body breaks down these medicines, so some people get better quickly while others may need a different dose or a different drug. These differences can also change the chance of side effects, such as stomach upset, sleepiness, or a stronger-than-expected reaction. Genetic testing is not a routine part of care for perinephritis, but if medicines are not working as expected or side effects are a problem, your care team may look more closely at how your body handles them.
Pharmacological treatments
Treatment for perinephritis usually focuses on clearing the infection and easing pain, because this condition often happens when infection spreads into the tissues around a kidney. The exact drug plan depends on how sick someone is, what germ is causing the problem, and whether there is an abscess or blockage that also needs a procedure. Not everyone responds to the same medication in the same way, so doctors may start with broad treatment and then adjust it when urine, blood, or drainage cultures come back.
Antibiotics are the main drug treatment for perinephritis when bacteria are the cause. Doctors often start with broad-spectrum antibiotics such as ceftriaxone, piperacillin-tazobactam, or a fluoroquinolone, then switch to a more targeted option once test results are available.
If perinephritis is causing high fever, vomiting, low blood pressure, or severe illness, treatment often starts with intravenous antibiotics in the hospital. Common choices include cefepime, piperacillin-tazobactam, or a carbapenem such as meropenem, especially if resistant bacteria are a concern.
Once fever and pain improve, many people with perinephritis can change from IV treatment to antibiotic pills. Options may include amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, ciprofloxacin, or levofloxacin if the germ is sensitive to them.
Pain medicines can help with flank pain, fever, and the body aches that often come with this illness. Acetaminophen is commonly used, and some people may also be offered an anti-inflammatory drug if kidney function allows it.
Genetic influences
Perinephritis is not usually considered an inherited condition. Most cases happen because of an infection or nearby inflammation around the kidney, rather than from a single gene change passed down in a family. It’s natural to ask whether family history plays a role. In some families, inherited tendencies that increase the chance of urinary blockage, kidney stones, diabetes, or immune system problems may indirectly raise the risk of perinephritis. Even so, genetics is usually only a small part of the picture, and not the main cause of perinephritis. If perinephritis keeps coming back or several relatives have similar kidney or urinary problems, a doctor may look for an underlying inherited issue.
Is Perinephritis genetic?
Genetics are not thought to play a major role in perinephritis. Most cases are linked to infection, blockage, injury, or nearby inflammation rather than inherited genetic variations.
Having a genetic risk is not necessarily a diagnosis
Genetic variants are a normal feature of human biology and are common throughout the general population. Most of these variants do not directly affect health and are simply part of natural human diversity. For many genes, having a variant associated with a condition points to a possible link rather than a definite diagnosis, especially when several genes and environmental factors are involved. In some cases, though, a single well-characterized variant in a particular gene is enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
When treating perinephritis, doctors usually choose antibiotics based on the likely bacteria, culture results, whether a fluid collection needs drainage, and how well the kidneys are working. Human genetics do not guide most perinephritis treatment, but they can matter in a few drug-safety decisions. Not every difference in response is genetic, but inherited changes can affect how some people handle certain medicines. For example, people with an inherited enzyme condition called G6PD deficiency may have a higher risk of red blood cell breakdown with some antibiotics, including certain sulfa drugs, so a different antibiotic may be safer. A rare inherited change in mitochondrial DNA can also greatly raise the risk of hearing loss from aminoglycoside antibiotics such as gentamicin or amikacin, which are sometimes used in severe kidney-area infections. In practice, how genetics affect antibiotic treatment for perinephritis is still more limited than factors like the germ involved, kidney function, allergies, pregnancy, and side effects, but known genetic risks can help doctors choose safer treatment.
Interactions with other conditions
Perinephritis often happens alongside other urinary tract problems, especially a kidney infection, a blocked ureter, or kidney stones, and these related conditions can make pain, fever, and feeling generally unwell more intense. Doctors call it a comorbidity when two conditions occur together. For many living with perinephritis, this matters because diabetes, a weakened immune system, or long-term kidney disease can raise the chance that an infection will spread beyond the kidney and become harder to clear. Someone might notice that what first seemed like a simple urinary infection gets worse instead of better, with ongoing flank pain or fever that does not settle. Perinephritis can also interact with serious infections in the bloodstream, sometimes called sepsis, and that is one reason early symptoms of perinephritis need prompt medical attention. If there is an underlying blockage, abscess, or stone, treating that problem is often just as important as treating the infection itself.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Perinephritis?
Perinephritis can look a lot like a kidney infection, a urine infection, or kidney stones because all of these can cause pain in the side or lower back, fever, nausea, and a general sick feeling. Doctors may also need to rule out problems such as a pulled back muscle, appendicitis, or gallbladder disease, since these can also cause belly or side pain that feels similar.
History
Long before modern scans and lab tests, severe pain in the side, fever, and deep tenderness around the kidney area could be hard to sort out. What we now call perinephritis was often grouped with other painful infections of the abdomen or urinary tract, so many living with it may not have had a clear diagnosis at first.
Initially understood only through symptoms, later perinephritis was recognized as inflammation in the tissues around the kidney rather than inside the kidney alone. As doctors improved bedside examination in the 1800s and early 1900s, they became better at noticing patterns such as persistent flank pain, fever, and swelling that suggested infection had spread beyond the urinary system. In the era before antibiotics, this could be a serious complication, sometimes following a kidney infection, an injury, or spread from a nearby infection.
Over time, surgery, urine testing, and later imaging changed the picture. X-rays offered limited clues, but ultrasound and CT scans made it much easier to see inflammation or pockets of pus around the kidney and to tell perinephritis apart from problems such as kidney stones, appendicitis, or gallbladder disease. For many, this meant fewer delays and a more accurate explanation for symptoms that might otherwise feel vague or confusing.
The history of perinephritis also reflects a broader change in medicine. As antibiotics became widely available, severe cases became less common in places with easier access to prompt treatment, although they still occur and can remain dangerous if missed. Today, doctors usually recognize the early symptoms of perinephritis more quickly than in the past, and treatment is guided by a clearer understanding of how infections can spread into the tissues surrounding the kidney.