Nephrolithiasis

Last reviewed: 19 Apr 2022
Last updated: 28 Oct 2020

Summary

Definition

History and exam

Key diagnostic factors

  • acute, severe flank pain
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • urinalysis
  • CBC and differential
  • serum electrolytes, BUN, and creatinine
  • urine pregnancy test
  • noncontrast helical CT scan
  • stone analysis
More 1st investigations to order

Investigations to consider

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

Treatment algorithm

INITIAL

acute renal colic nonpregnant

ACUTE

confirmed stone: no evidence of obstruction nonpregnant

confirmed stone: with evidence of obstruction nonpregnant

pregnant

ONGOING

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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