Nephrolithiasis

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Evidence last reviewed: 2 Apr 2026
Topic last updated: 30 Jan 2026

Summary

Definition

History and exam

Key diagnostic factors

  • acute, severe flank pain
Full details

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
Full details

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

  • urinalysis
  • CBC and differential
  • serum electrolytes, BUN, and creatinine
  • urine pregnancy test
  • noncontrast helical CT scan
  • stone analysis
Full details

Tests to consider

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

Emerging tests

  • dual-energy CT
Full details

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

Expert advisers

Russell Terry, MD

Assistant Professor of Urology

University of Florida College of Medicine

Gainesville, FL

Disclosures

RT declares that he has no competing interests.

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 topic.

Disclosures

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

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.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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. Mar 2025 [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

    • Acute appendicitis
    • Ectopic pregnancy
    • Ovarian cyst
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Urolithiasis
    • Medical management of kidney stones
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Kidney infection

    Kidney stones

    Mais Folhetos informativos para os pacientes
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal