Nephrolithiasis

Nephrolithiasis (kidney stones) is a common condition, typically affecting adult men more commonly than adult women, although this difference is narrowing.

Patients typically present with acute renal colic, although some patients are asymptomatic.

Multiple risk factors include chronic dehydration, diet, obesity, positive family history, specific medicines, and various metabolic abnormalities.

Arrange urgent (within 24 hours of presentation) low-dose non-contrast computed tomography (NCCT) for adults with suspected renal colic. If the patient is pregnant or aged under 16 years, arrange an urgent ultrasound instead of CT.

Manage the patient based on stone size, location, and composition, in addition to anatomical and clinical features. Treatment consists of both medical and surgical therapies.

Refer the patient for immediate urological consultation if they have a stone in the kidney or ureter together with signs and symptoms of infection, or obstruction alone.

In the absence of urgent considerations, the main goal of initial treatment for an acute stone event is symptomatic relief with hydration and analgesia as needed.

Prompt treatment of ureteric stones is important because of the risk of obstruction and kidney damage. Watchful waiting is not recommended for these patients.

Dietary modification with adequate hydration is an essential aspect of ongoing management.

Nephrolithiasis refers to the presence of crystalline stones (calculi) within the urinary system (kidneys and ureter). Such renal stones are composed of varying amounts of crystalloid and organic matrix. Ureteric stones almost always originate in the kidney but then pass down into the ureter.[1]Stoller ML. Urinary stone disease. In: Tanagho EA, McAninch JW, eds. Smith's General Urology, 16th edition. New York, NY: McGraw-Hill: 2004: 256-91. BMJ talk medicine: nephrolithiasis