Summary
Definition
History and exam
Other diagnostic factors
- risk factors
- previous episodes of nephrolithiasis
- nausea and vomiting
- urinary frequency/urgency
- haematuria
- testicular pain
- obesity
- family history of nephrolithiasis
- precipitant medications
- groin pain
- fever
- tachycardia
- hypotension
- costovertebral angle and ipsilateral flank tenderness
Risk factors
- 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
Diagnostic investigations
1st investigations to order
- urinalysis
- FBC and differential
- serum electrolytes, urea, and creatinine
- urine pregnancy test
- non-contrast helical CT scan (nonpregnant adult)
- renal ultrasound (pregnant or child)
Investigations to consider
- stone analysis
- plain abdominal radiograph (KUB)
- MRI
- spot urine for cystine
Treatment algorithm
Contributors
Expert advisers
Jonathan Murray, BSc (Hons), MBBS (Hons), MRCP
Consultant Nephrologist
UK Kidney Association Acute Kidney Injury Specialist Interest Group Co-Chair
South Tees Hospital NHS Foundation Trust
Middlesborough
UK
Disclosures
JM is co-chair for the UK Kidney Association Acute Kidney Injury Specialist Interest Group, co-chair for the UK Kidney MedTech Research Network, and a member of the Renal Service Transformation Programme Acute Kidney Injury Workstream. He was previously a Specialist Committee Member for the NICE Acute Kidney Injury Quality Standard update and an Expert Commentator for NICE Medtech Innovation Briefing. JM has co-authored national guidelines (NICE endorsed) for the UK Kidney Association, providing best practice guidance on providing renal support for critically ill patients during the COVID-19 pandemic.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Jodi Antonelli MD
Assistant Professor
Department of Urology
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures: JA is a member of the Scientific Advisory Board for Boston Scientific. JA has received a research grant from the US National Institutes of Health to study strategies to reduce recurrence of nephrolithiasis and reduce stent-associated pain.
Naim Maalouf MD
Associate Program Director
Associate Professor
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures: NM has received a research grant from the US National Institutes of Health to study strategies to reduce recurrence of nephrolithiasis and reduce stent-associated pain.
Russell Terry MD
Assistant Professor of Urology
University of Florida College of Medicine
Gainesville
FL
Disclosures: RT declares that he has no competing interests.
Peer reviewers
John Sayer, MBBS
Professor of Renal Medicine
Deputy Dean
Biosciences Institute
Faculty of Medical Sciences
Newcastle University
Newcastle upon Tyne
UK
Disclosures
Not disclosed.
Andrew Dickinson, MBBS, FRCS, FRCSEd, MD, FRCS(Urol)
Consultant Urologist
Derriford Hospital
University Hospitals Plymouth NHS Trust
Plymouth
UK
Disclosures
AD was Chair of the NICE guidelines committee on renal and ureteric stones: assessment and management, 2017-2019.
Editors
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
Disclosures
JH declares that she has no competing interests.
Annabel Sidwell
Comorbidities Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Use of this content is subject to our disclaimer