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
acute renal colic, non-pregnant
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
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.
Differentials
- Acute appendicitis
- Ectopic pregnancy
- Ovarian cyst
More DifferentialsGuidelines
- Urolithiasis
- Renal and ureteric stones: assessment and management
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