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Nefrolitíase

Última revisão: 27 Nov 2025
Última atualização: 01 Oct 2025

Resumo

Definição

History and exam

Key diagnostic factors

  • dor aguda e grave no flanco
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

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

Tests to consider

  • 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
Full details

Emerging tests

  • tomografia computadorizada (TC) de fonte dupla

Treatment algorithm

INITIAL

cólica renal aguda fora da gravidez

ACUTE

cálculo confirmado: sem evidência de obstrução, não gestante

cálculo confirmado: com evidência de obstrução, não gestante

gestante

ONGOING

após episódio agudo fora da gestação

Contributors

Authors

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

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.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Pearle MS, Goldfarb DS, Assimos DG, et al; American Urological Assocation. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24.Full text  Abstract

European Association of Urology. Urolithiasis. Apr 2024 [internet publication].Full text

Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline. 2016 [internet publication].Full text  Abstract

Reference articles

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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