A 45-year-old man presents to the emergency department with a 1-hour history of sudden onset of left-sided flank pain radiating down towards his groin. The patient is writhing in pain, which is unrelieved by position. He also complains of nausea and vomiting.
Many patients with nephrolithiasis are actually asymptomatic, as their stone may be in the kidney and non-obstructing. In these patients, diagnosis may be made following imaging (CT scan, abdominal x-ray, renal ultrasound, etc.) for other reasons. In contrast, other patients may present with gross haematuria, evidence of an obstructive uropathy, or sepsis with fever, tachycardia, and hypotension.
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