Last reviewed: 14 Apr 2021
Last updated: 20 Jan 2021

Summary

Definition

History and exam

Key diagnostic factors

  • acute, severe flank pain

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
  • crystalluria
  • occupational exposure to dehydration
  • warm climate
  • family history of nephrolithiasis
  • precipitant medications

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

Investigations to consider

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

Treatment algorithm

Contributors

Expert advisersVIEW ALL

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.

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 reviewersVIEW ALL

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.

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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