Nephrolithiasis

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Última revisión: 20 Aug 2025
Última actualización: 21 Jan 2025

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • acute, severe flank pain
Todos los datos

Otros factores de diagnóstico

  • previous episodes of nephrolithiasis
  • nausea and vomiting
  • urinary frequency/urgency
  • hematuria
  • testicular pain
  • obesity
  • family history of nephrolithiasis
  • precipitant medications
  • groin pain
  • fever
  • tachycardia
  • hypotension
  • costovertebral angle and ipsilateral flank tenderness
Todos los datos

Factores de riesgo

  • dehydration
  • high salt intake
  • white ancestry
  • male sex
  • obesity and metabolic syndrome
  • crystalluria
  • gastrointestinal surgery
  • occupational exposure to dehydration
  • warm climate
  • family history of nephrolithiasis
  • precipitant medications
  • dietary animal protein intake
  • ascorbic acid supplementation
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • urinalysis
  • CBC and differential
  • serum electrolytes, BUN, and creatinine
  • urine pregnancy test
  • noncontrast helical CT scan
  • stone analysis
Todos los datos

Pruebas diagnósticas que deben considerarse

  • plain abdominal radiograph (KUB)
  • renal ultrasound
  • intravenous pyelogram (IVP)
  • magnetic resonance imaging (MRI)
  • 24-hour urine monitoring
  • spot urine for cystine
Todos los datos

Pruebas emergentes

  • dual-energy CT
Todos los datos

Algoritmo de tratamiento

Inicial

acute renal colic nonpregnant

Agudo

confirmed stone: no evidence of obstruction nonpregnant

confirmed stone: with evidence of obstruction nonpregnant

pregnant

En curso

following an acute episode nonpregnant

Colaboradores

Consejeros especializados

Russell Terry, MD

Assistant Professor of Urology

University of Florida College of Medicine

Gainesville

FL

Divulgaciones

RT declares that he has no competing interests.

Agradecimientos

Dr Jodi Antonelli and Dr Naim Maalouf would like to gratefully acknowledge Dr Brian Eisner, Dr Michael E. Lipkin, Dr Muhammad Iqbal, Dr Keith Xavier, and Dr Mantu Gupta, previous contributors to this topic.

Divulgaciones

BE has received fees for consulting from Boston Scientific, Olympus/Gyrus ACMI, PercSys, and The Ravine Group. MEL declares that he is a consultant for Boston Scientific Corporation. MI, KX, and MG declare that they have no competing interests.

Revisores por pares

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

TX

Divulgaciones

RT declares that he has no competing interests.

Lynda Frassetto, MD

Associate Professor of Medicine

Division of Nephrology

University of California at San Francisco

CA

Divulgaciones

LF declares that she has no competing interests.

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Divulgaciones

IM declares that he has no competing interests.

Nagaraja Rao, MBBS, ChM, FRCS

Consultant Urological Surgeon

Spire Manchester Hospital

Manchester

UK

Divulgaciones

NR declares no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24.Texto completo  Resumen

European Association of Urology. Urolithiasis. Apr 2024 [internet publication].Texto completo

Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline. 2016 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

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