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Nefrolitíase

Last reviewed: 13 Sep 2025
Last updated: 16 Jan 2024

Summary

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • dor aguda e grave no flanco
Todos los datos

Otros factores de diagnóstico

  • episódios prévios de nefrolitíase
  • náuseas e vômitos
  • polaciúria/urgência urinária
  • hematúria
  • dor testicular
  • obesidade
  • história familiar de nefrolitíase
  • medicamentos precipitadores
  • dor na virilha
  • febre
  • taquicardia
  • hipotensão
  • sensibilidade no ângulo costovertebral e no flanco ipsilateral
Todos los datos

Factores de riesgo

  • desidratação
  • ingestão elevada de sal
  • ascendência branca
  • sexo masculino
  • obesidade e síndrome metabólica
  • cristalúria
  • cirurgia gastrointestinal
  • exposição ocupacional à desidratação
  • clima quente
  • história familiar de nefrolitíase
  • medicamentos precipitadores
  • ingestão alimentar de proteína animal
  • suplementação de ácido ascórbico
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • urinálise
  • hemograma completo e diferencial
  • eletrólitos séricos, ureia e creatinina
  • teste de gravidez na urina
  • tomografia computadorizada helicoidal sem contraste
  • análise do cálculo
Todos los datos

Pruebas diagnósticas que deben considerarse

  • radiografia abdominal simples (RUB, rins, ureteres e bexiga)
  • ultrassonografia renal
  • pielograma intravenoso (PIV)
  • ressonância nuclear magnética (RNM)
  • monitoramento da urina de 24 horas
  • amostra de urina para cistina
Todos los datos

Pruebas emergentes

  • Tomografia computadorizada (TC) de fonte dupla

Algoritmo de tratamiento

Inicial

cólica renal aguda fora da gravidez

Agudo

cálculo confirmado: sem evidência de obstrução, não gestante

cálculo confirmado: com evidência de obstrução, não gestante

gestante

En curso

após episódio agudo fora da gestação

Colaboradores

Autores

Russell Terry, MD

Assistant Professor of Urology

University of Florida College of Medicine

Gainesville

FL

Divulgaciones

RT declares that he has no competing interests.

Agradecimientos

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.

Revisores por pares

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

TX

Divulgaciones

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

Divulgaciones

LF declares that she has no competing interests.

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Divulgaciones

IM declares that he has no competing interests.

Nagaraja Rao, MBBS, ChM, FRCS

Consultant Urological Surgeon

Spire Manchester Hospital

Manchester

UK

Divulgaciones

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.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

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  Resumen

European Association of Urology. Urolithiasis. Mar 2023 [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  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

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