Nephrolithiasis

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Última revisão: 12 Aug 2025
Última atualização: 21 Jan 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • acute, severe flank pain
Detalhes completos

Outros fatores diagnósticos

  • previous episodes of nephrolithiasis
  • nausea and vomiting
  • urinary frequency/urgency
  • hematuria
  • testicular pain
  • obesity
  • family history of nephrolithiasis
  • precipitant medications
  • groin pain
  • fever
  • tachycardia
  • hypotension
  • costovertebral angle and ipsilateral flank tenderness
Detalhes completos

Fatores de risco

  • 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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • urinalysis
  • CBC and differential
  • serum electrolytes, BUN, and creatinine
  • urine pregnancy test
  • noncontrast helical CT scan
  • stone analysis
Detalhes completos

Investigações a serem consideradas

  • plain abdominal radiograph (KUB)
  • renal ultrasound
  • intravenous pyelogram (IVP)
  • magnetic resonance imaging (MRI)
  • 24-hour urine monitoring
  • spot urine for cystine
Detalhes completos

Novos exames

  • dual-energy CT
Detalhes completos

Algoritmo de tratamento

Inicial

acute renal colic nonpregnant

AGUDA

confirmed stone: no evidence of obstruction nonpregnant

confirmed stone: with evidence of obstruction nonpregnant

pregnant

CONTÍNUA

following an acute episode nonpregnant

Colaboradores

Consultores especialistas

Russell Terry, MD

Assistant Professor of Urology

University of Florida College of Medicine

Gainesville

FL

Declarações

RT declares that he has no competing interests.

Agradecimentos

Dr Jodi Antonelli and Dr Naim Maalouf would like to gratefully acknowledge Dr Brian Eisner, Dr Michael E. Lipkin, Dr Muhammad Iqbal, Dr Keith Xavier, and Dr Mantu Gupta, previous contributors to this topic.

Declarações

BE has received fees for consulting from Boston Scientific, Olympus/Gyrus ACMI, PercSys, and The Ravine Group. MEL declares that he is a consultant for Boston Scientific Corporation. MI, KX, and MG declare that they have no competing interests.

Revisores

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

TX

Declarações

RT declares that he has no competing interests.

Lynda Frassetto, MD

Associate Professor of Medicine

Division of Nephrology

University of California at San Francisco

CA

Declarações

LF declares that she has no competing interests.

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Declarações

IM declares that he has no competing interests.

Nagaraja Rao, MBBS, ChM, FRCS

Consultant Urological Surgeon

Spire Manchester Hospital

Manchester

UK

Declarações

NR declares no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24.Texto completo  Resumo

European Association of Urology. Urolithiasis. Apr 2024 [internet publication].Texto completo

Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline. 2016 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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