Resumo
Definição
History and exam
Key diagnostic factors
- dor aguda e grave no flanco
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
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
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
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
Emerging tests
- tomografia computadorizada (TC) de fonte dupla
Treatment algorithm
cólica renal aguda fora da gravidez
cálculo confirmado: sem evidência de obstrução, não gestante
cálculo confirmado: com evidência de obstrução, não gestante
gestante
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
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.
Differentials
- Apendicite aguda
- Gravidez ectópica
- Cisto ovariano
More DifferentialsGuidelines
- Urolithiasis
- Medical management of kidney stones
More GuidelinesPatient information
Nefrolitíase
Infecção renal
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer