Nephrolithiasis

Last reviewed: 6 Sep 2022
Last updated: 20 Jan 2021

Summary

Definition

History and exam

Key diagnostic factors

  • acute, severe flank pain
Full details

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
Full details

Risk factors

  • dehydration
  • high salt intake
  • white ancestry
  • male sex
  • obesity
  • crystalluria
  • occupational exposure to dehydration
  • warm climate
  • family history of nephrolithiasis
  • precipitant medications
Full details

Diagnostic investigations

1st investigations to order

  • non-contrast helical CT scan (nonpregnant adult)
  • renal ultrasound (pregnant or child)
  • urinalysis
  • FBC and differential
  • serum electrolytes, urea, and creatinine
  • urine pregnancy test
Full details

Investigations to consider

  • stone analysis
  • plain abdominal radiograph (KUB)
  • MRI
  • spot urine for cystine
Full details

Treatment algorithm

INITIAL

acute renal colic, non-pregnant

ACUTE

confirmed renal or ureteric stone: with evidence of obstruction, non-pregnant

confirmed renal stone: no evidence of obstruction, non-pregnant

confirmed ureteric stone: no evidence of obstruction, non-pregnant

pregnant

ONGOING

following an acute episode, non-pregnant

Contributors

Expert advisers

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.

Peer reviewers

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.

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