Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- acute, severe flank pain
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
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
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
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
Novos exames
- dual-energy CT
Algoritmo de tratamento
acute renal colic nonpregnant
confirmed stone: no evidence of obstruction nonpregnant
confirmed stone: with evidence of obstruction nonpregnant
pregnant
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
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.
Diagnósticos diferenciais
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