小结
定义
病史和体格检查
关键诊断因素
- acute, severe flank pain
其他诊断因素
- 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
危险因素
- 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
诊断性检查
首要检查
- urinalysis
- CBC and differential
- serum electrolytes, BUN, and creatinine
- urine pregnancy test
- noncontrast helical CT scan
- stone analysis
需考虑的检查
- plain abdominal radiograph (KUB)
- renal ultrasound
- intravenous pyelogram (IVP)
- magnetic resonance imaging (MRI)
- 24-hour urine monitoring
- spot urine for cystine
新兴检查
- dual-energy CT
治疗流程
acute renal colic nonpregnant
confirmed stone: no evidence of obstruction nonpregnant
confirmed stone: with evidence of obstruction nonpregnant
pregnant
following an acute episode nonpregnant
撰稿人
专家顾问
Russell Terry, MD
Assistant Professor of Urology
University of Florida College of Medicine
Gainesville, FL
利益声明
RT declares that he has no competing interests.
鸣谢
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.
利益声明
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.
同行评议者
Robert Tompkins, MD
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler, TX
利益声明
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
利益声明
LF declares that she has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard, IL
利益声明
IM declares that he has no competing interests.
Nagaraja Rao, MBBS, ChM, FRCS
Consultant Urological Surgeon
Spire Manchester Hospital
Manchester
UK
利益声明
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.
参考文献
关键文献
Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24.全文 摘要
European Association of Urology. Urolithiasis. Mar 2025 [internet publication].全文
Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline. 2016 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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