Summary
Definition
History and exam
Key diagnostic factors
- acute, severe flank pain
Other diagnostic factors
- 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
Risk factors
- high protein intake
- high salt intake
- white ancestry
- male sex
- dehydration
- obesity
- crystalluria
- occupational exposure to dehydration
- warm climate
- family history of nephrolithiasis
- precipitant medications
Diagnostic investigations
1st investigations to order
- urinalysis
- CBC and differential
- serum electrolytes, BUN, and creatinine
- urine pregnancy test
- noncontrast helical CT scan
- stone analysis
Investigations to consider
- plain abdominal radiograph (KUB)
- renal ultrasound
- intravenous pyelogram (IVP)
- magnetic resonance imaging (MRI)
- 24-hour urine monitoring
- spot urine for cystine
Treatment algorithm
acute renal colic nonpregnant
confirmed stone: no evidence of obstruction nonpregnant
confirmed stone: with evidence of obstruction nonpregnant
pregnant
following an acute episode nonpregnant
Contributors
Authors
Jodi Antonelli, MD
Assistant Professor
Department of Urology
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures
JA has received a grant for being a member of the Scientific Advisory Board for Boston Scientific, a company that manufactures products for kidney stone surgery. 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.
Acknowledgements
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 monograph. 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.
Peer reviewers
Robert Tompkins, MD
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler
TX
Disclosures
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
Disclosures
LF declares that she has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Disclosures
IM declares that he has no competing interests.
Nagaraja Rao, MBBS, ChM, FRCS
Consultant Urological Surgeon
Spire Manchester Hospital
Manchester
UK
Disclosures
NR declares no competing interests.
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- Ectopic pregnancy
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