Acute renal colic is a common presentation in general practice, so a basic understanding of its evaluation and treatment would be useful. [bmj.com]

For patients presenting with acute renal colic, especially those with body mass index of KEYWORDS: Computed tomography; Imaging technique; Ionizing; Kidney stones; Nephrolithiasis; Radiation exposure [ncbi.nlm.nih.gov]

• Pain

  Kidney stones are a common cause of blood in the urine and pain in the abdomen, flank, or groin. Kidney stones occur in 1 in 10 people at some time in their life. [medicinenet.com]

  Whereas the pain of biliary or intestinal colic is intermittent, the pain of renal colic is more constant but there are often periods of relief or just a dull ache before it returns. The pain may change as the stone moves. [patient.info]

  A Caucasian man aged 25 years had sudden bilateral inguinal and occasional periumbilical pain. [ncbi.nlm.nih.gov]

  In the acute setting, initial medical management should include pain control (NSAIDs for outpatient up to three days before a procedure, Toradol and opiods in inpatient for severe pain), urine culture, and imaging of the stone. [pedclerk.bsd.uchicago.edu]

  Symptoms  Pain (Unilateral or bilateral flank pain).  Nausea.  Vomiting.  Urinary frequency.  Haematuria.  Abdominal pain.  Dysuria.  Nocturia.  Fever / Chills.  Abnormal urine color or smell 8. Investigations  Laboratory a. [slideshare.net]

• Severe Pain

  However, urologic intervention should be initiated for unremitting severe pain and urinary obstruction. [pedclerk.bsd.uchicago.edu]

  This is common with any severe pain. There may be severe pain in the testis but the testis should not be tender. Blood pressure may be low. [patient.info]

  A small stone may pass out without causing symptoms but if it grows to more than 5mm it can cause severe pain. Hope you enjoy the video and understand the genesis and management of kidney stones. [uskeys.net]

  Others, however, can have severe kidney pain, infection, and inflammation. The most severe pain occurs where the passage of urine from the kidney is obstructed by the stone. Treatment includes medications to clear up infections and to relieve pain. [britannica.com]

• Asymptomatic

  After 30 months, he continues to be asymptomatic without recurrence of nephrolithiasis. This constitutes the fifth such reported case. [ncbi.nlm.nih.gov]

• Recurrent Urinary Tract Infection

  Although none of the patients had been previously hospitalized for symptomatic nephrolithiasis, nine with Crohn’s disease and five with ulcerative colitis had recurrent urinary tract infections or hydronephrosis. [dovepress.com]

  tract infections Urine acidification Usually require surgical stone removal Urinary tract infections can cause the formation of struvite stones, but struvite stones also increase the risk of urinary tract infections. [amboss.com]

  […] investigated for irritable bladder symptoms or recurrent urinary tract infections.[8] Patients with indwelling Foley catheters are also at high risk for developing bladder stones and there appears to be a significant association between bladder stones [patient.info]

  This type of stone is also called an infection stone because it forms in urine that is infected with bacteria form in response to an infection, such as a urinary tract infection. [bouldermedicalcenter.com]

  Complications Recognized complications include: spontaneous extravasation: spontaneous rupture of renal pelvis (SRRP) +/- urinoma formation 4 recurrent urinary tract infections ( pyelonephritis ) impaction of the stone along the ureter may result in hydroureter [radiopaedia.org]

• Nausea

  Nausea and vomiting are common. Treatment includes relief of pain, hydration and, if there is concurrent urinary infection, antibiotics. The majority of stones pass spontaneously within 48 hours. [medicinenet.com]

  Nausea and vomiting are common. Renal Calculi [omicsonline.org]

  Diagnosis and differential diagnosis Diagnostic criteria Signs and symptoms of nephrolithiasis include: Sudden onset of severe pain, arising from the flank and radiating to the groin Possible writhing and pacing, depending on level of obstruction Nausea [cancertherapyadvisor.com]

  A 64-year-old man with HIV on antiretroviral therapy (including atazanavir, a protease inhibitor) presented with left flank pain, nausea and vomiting. [ncbi.nlm.nih.gov]

  Typical symptoms of acute renal colic are intermittent colicky flank pain that may radiate to the lower abdomen or groin, often associated with nausea and vomiting. 3 Lower urinary tract symptoms such as dysuria, urgency, and frequency may occur once [bmj.com]

• Vomiting

  Nausea and vomiting are common. Treatment includes relief of pain, hydration and, if there is concurrent urinary infection, antibiotics. The majority of stones pass spontaneously within 48 hours. [medicinenet.com]

  Management Antepartum/Intrapartum/Postpartum Obtain IV access and aggressive hydration (patients often have dehydration due to vomiting and decrease po intake). IV narcotics (Morphine, meperidine, or butorphanol are most common) for pain control. [cancertherapyadvisor.com]

  Nausea and vomiting are common. Renal Calculi [omicsonline.org]

  A 64-year-old man with HIV on antiretroviral therapy (including atazanavir, a protease inhibitor) presented with left flank pain, nausea and vomiting. [ncbi.nlm.nih.gov]

  Typical symptoms of acute renal colic are intermittent colicky flank pain that may radiate to the lower abdomen or groin, often associated with nausea and vomiting. 3 Lower urinary tract symptoms such as dysuria, urgency, and frequency may occur once [bmj.com]

• Abdominal Pain

  Due to its variable presentations, it is usually discovered incidentally, especially when investigating patients for abdominal pain. [ncbi.nlm.nih.gov]

  flank pain, upper abdominal pain Middle section of ureter Renal colic, anterior abdominal pain, flank pain Distal ureter Renal colic, dysuria, urinary frequency, anterior abdominal pain, flank pain Distal ureteral stones may be manifested by bladder [aafp.org]

  Anahtar Kelime:Nephrolithiasis,Abdominal Pain,Acute Renal Artery Thrombosis [atif.sobiad.com]

  pain Nausea Emesis (vomiting) Peptic ulcer Pancreatitis (inflammation of the pancreas) Bone disease Nefrolithiasis Complications: Diagnostics: Calcium (high) Vitamine D deficiencys occur often Mild metabolic acidosis Hypophosphataemia Calcitrol increased [encymed.com]

• Suprapubic Pain

  CONCLUSIONS: Nephrolithiasis is a rare complication of pediatric DKA, and should be considered in children with DKA who develop hematuria, flank pain, or suprapubic pain. [ncbi.nlm.nih.gov]

  Suprapubic pain along with urinary urgency and frequency suggests a distal ureteral, ureterovesical, or bladder calculus (see Obstructive Uropathy: Symptoms and Signs). [msdmanuals.com]

  These symptoms include suprapubic pain, urinary frequency, urgency, dysuria, stranguria, pain at the tip of the penis, and sometimes various bowel symptoms, such as diarrhea and tenesmus. [emedicine.medscape.com]

• Right Flank Pain

  A 36-year-old man was admitted to hospital due to right flank pain as a result of ureteral stones. He had been followed up for type 1 glycogen storage disease since the age of 11 years. [ncbi.nlm.nih.gov]

  After 8 months of treatment with dorzolamide, she noted polyuria and right flank pain, which prompted her to seek evaluation by a local physician. [jamanetwork.com]

  Case A 39-year-old woman presented to the ED with a chief complaint of intermittent right flank pain that radiated into her groin area. She stated the pain had begun suddenly, 4 hours prior to arrival, and was accompanied by nausea and vomiting. [mdedge.com]

• Tachycardia

  Obtain vital signs, and monitor for fever and symptoms of impending sepsis (tachycardia, hypotension). [slideshare.net]

  Dysuria (burning pain on micturation) Tachycardia Decreased blood pressure – can lead to septic shock. [almostadoctor.co.uk]

  This may be accompanied by nausea, vomiting, tachycardia Bladder stone Characterised by dysuria( pain or burning during micturition), frequency and urgency 6. [de.slideshare.net]

  Vital signs during an episode of renal colic may indicate hypertension and tachycardia, but patients should not be febrile. Fever may suggest UTI, pyelonephritis or even pyonephrosis if kidney is obstructed. [cancertherapyadvisor.com]

• Back Pain

  […] type - code to pain by site, such as: abdomen pain ( R10.- ) back pain ( M54.9 ) breast pain ( N64.4 ) chest pain ( R07.1- R07.9 ) ear pain ( H92.0- ) eye pain ( H57.1 ) headache ( R51 ) joint pain ( M25.5- ) limb pain ( M79.6- ) lumbar region pain [icd10data.com]

  Stones in your bladder may cause pain in the lower abdomen (belly area). Stones in a kidney or ureter may cause back pain, usually in the area between your ribs and hip. The pain can also be across your belly and down between your legs. [merckmanuals.com]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Hematuria Flank pain Colicky back pain Laboratory Testing Initial testing Urinalysis Point-of-care testing for hematuria Urine microscopic testing Blood indicates injury due to crystal passage [arupconsult.com]

  Symptoms of Nephrolithiasis (Kidney Stones; Renal Calculi; Urinary Stones) Symptoms of renal stone disease may include: Pain: unilateral or bilateral flank or back pain. [healthengine.com.au]

• Costovertebral Angle Tenderness

  Physical examination is significant for left-sided costovertebral angle tenderness. Urine dipstick is heme positive. Urinalysis also shows envelope-shaped crystals. A non-contrast abdominal CT is shown. [medbullets.com]

  angle) tenderness Microscopic hematuria Diagnostic tests CBC with differential Serum calcium, phosphorus, uric acid and creatine Urinalysis Urine culture and sensitivity Urine microcopy Imaging studies Renal ultrasound Non-invasive, safe in pregnancy [cancertherapyadvisor.com]

  Severe unilateral and colicky flank pain (renal colic) Radiates anteriorly to the lower abdomen, groin, labia, testicles, or perineum Paroxysmal or progressively worsening The area around the kidneys may be tender on percussion (costovertebral angle tenderness [amboss.com]

  The abdomen may be somewhat tender on the affected side as palpation increases pressure in the already-distended kidney (costovertebral angle tenderness), but peritoneal signs (guarding, rebound, rigidity) are lacking. [msdmanuals.com]

• Agitation

  The patients are usually restless and agitated. Diagnosis & Laboratory Investigations of Nephrolithiasis Urine Examination Image: “Calcium oxalate crystals: Envelope and dumbbell shaped crystals in the urine” by Doruk Salancı. [lecturio.com]

• Hematuria

  There was a family history of renal stones in both maternal and paternal grandparents and of microscopic hematuria in the mother. There was no associated urinary flow obstruction and the hematuria remitted spontaneously. [ncbi.nlm.nih.gov]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Hematuria Flank pain Colicky back pain Laboratory Testing Initial testing Urinalysis Point-of-care testing for hematuria Urine microscopic testing Blood indicates injury due to crystal passage [arupconsult.com]

• Flank Pain

  A 64-year-old man with HIV on antiretroviral therapy (including atazanavir, a protease inhibitor) presented with left flank pain, nausea and vomiting. [ncbi.nlm.nih.gov]

  The authors review appropriate workup and treatment for patients presenting with signs and symptoms of flank pain consistent with renal colic. [mdedge.com]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Hematuria Flank pain Colicky back pain Laboratory Testing Initial testing Urinalysis Point-of-care testing for hematuria Urine microscopic testing Blood indicates injury due to crystal passage [arupconsult.com]

  Typical symptoms of acute renal colic are intermittent colicky flank pain that may radiate to the lower abdomen or groin, often associated with nausea and vomiting. 3 Lower urinary tract symptoms such as dysuria, urgency, and frequency may occur once [bmj.com]

• Kidney Failure

  APRT Deficiency APRT deficiency is a disorder that causes kidney stones, and chronic kidney disease leading to kidney failure in some cases. The stones are made up of 2,8 dihydroxyadenine (DHA), and can be confused with uric acid. [rarediseasesnetwork.org]

  Risk of end-stage renal failure (ESRD) Principal investigator: Andrew D. Rule, M.D. [mayo.edu]

  If the obstruction is long (more than 2-3 weeks), the high pressure can cause irreparable damage to the kidney tissue (see chronic kidney failure). [healthanddisease.com]

  By 15 years of even mild high calcium, 80% of patients will have some renal failure, usually it is Stage III kidney failure at this time. We have a blog discussing kidney failure and stones which includes x-rays and pictures. [parathyroid.com]

• Microscopic Hematuria

  There was a family history of renal stones in both maternal and paternal grandparents and of microscopic hematuria in the mother. There was no associated urinary flow obstruction and the hematuria remitted spontaneously. [ncbi.nlm.nih.gov]

  Gross or microscopic hematuria is found in 33% to 90% of children who have urolithiasis and occurs equally across age groups. Urinary tract infection frequently is the presenting sign of urolithiasis in preschool-age children. [pedsinreview.aappublications.org]

  […] nephrolithiasis include: Sudden onset of severe pain, arising from the flank and radiating to the groin Possible writhing and pacing, depending on level of obstruction Nausea and vomiting (one-half of patients) CVA (costovertebral angle) tenderness Microscopic [cancertherapyadvisor.com]

• Renal Pain

  Tenesmus after urination TABACUM Renal colic usually left sided. Violent pain along the ureter. Sometimes associated with vertigo and vomiting THUJA OCCIDENTALIS Renal calculus usually left sided. Frequent urination accompanying pain 3 12. [de.slideshare.net]

  Development of renal colic pain and renal damage The colicky-type pain known as renal colic usually begins in the upper lateral midback over the costovertebral angle and occasionally subcostally. [emedicine.medscape.com]

  Kidney stones can cause abdominal or back pain (known as renal colic). Renal colic usually begins sporadically but then becomes constant and can lead to nausea and vomiting. The site of pain can change as the stone moves through the urinary tract. [malacards.org]

All patients were seen at least twice and had undergone a metabolic workup. RESULTS: A total of 260 return patients were seen during the period 2010-2015. The male:female ratio was 3.1:1. Mean age at the first stone event was 44.1 years. [ncbi.nlm.nih.gov]

The authors review appropriate workup and treatment for patients presenting with signs and symptoms of flank pain consistent with renal colic. [mdedge.com]

The first kidney stone in a child prompts a more complete workup. [arupconsult.com]

References:[1][7] Diagnostics Initial diagnostic workup includes imaging studies to locate the stone and laboratory tests to determine kidney function and assess for UTI. [amboss.com]

• Nephrolithiasis

  Nephrolithiasis: Small calyceal stone in a lowerpole calyx Nephrolithiasis: Calculus in the renal pelvis without dilatation in a 1 year old girl Nephrolithiasis: Large staghorn calculus in the left kidney in a 5 year old child Nephrolithiasis: Bilateral [ultrasoundcases.info]

  Epidemiology The incidence of nephrolithiasis in children is lower in children than in adults. [pedclerk.bsd.uchicago.edu]

  Nephrolithiasis: The process of forming a kidney stone, a stone in the kidney (or lower down in the urinary tract). Kidney stones are a common cause of blood in the urine and pain in the abdomen, flank, or groin. [medicinenet.com]

  The aim of this study was to compare urine and serum metabolic compositions in IPAA patients with nephrolithiasis and controls with IPAA and no nephrolithiasis. [ncbi.nlm.nih.gov]

• Small Kidney

  Treatment Treatment for kidney stones varies, depending on the type of stone and the cause. Small stones with minimal symptoms Most small kidney stones won't require invasive treatment. You may be able to pass a small stone by: Drinking water. [mayoclinic.org]

  The medical term for kidney stones is nephrolithiasis, and if they cause severe pain it's known as renal colic. Symptoms of kidney stones Small kidney stones may go undetected and be passed out painlessly in the urine. [nhs.uk]

  Subsequently, the small stone pieces are flushed out of the kidney. The latest advances in this method allow the use of devices with a diameter of only 4 millimeters in some cases. [ims.uniklinik-freiburg.de]

  Small kidney stones may also be asymptomatic and detected incidentally. [amboss.com]

  Other symptoms of kidney stones can include: blood in the urine (red, pink, or brown urine) vomiting nausea discolored or foul-smelling urine chills fever frequent need to urinate urinating small amounts of urine In the case of a small kidney stone, you [healthline.com]

• Hyperuricosuria

  CONCLUSION: The most frequent metabolic alterations in females were hypocitraturia, urinary tract infection, low urinary volume and hyperuricosuria. [ncbi.nlm.nih.gov]

  IBD, CF, pancreatitis, extensive bowel resection are risk factors Excessive oxalate ingestion Ethylene glycol, ascorbic acid are metabolized to oxalate Hyperuricosuria – 2-8 % of pediatric nephrolithiasis Uric acid excretion higher in children than adults [pedclerk.bsd.uchicago.edu]

• Pyuria

  The presence of pyuria, however, has only moderate accuracy in identifying UTIs in patients with kidney stones.4 If an infected stone cannot be excluded clinically, computed tomography (CT) is indicated. [mdedge.com]

  Laboratory tests ↑ WBC: suggests concomitant UTI ↑ Serum urea nitrogen and creatinine: suggests acute kidney injury Urine dipstick and urinalysis Gross or microscopic hematuria Pyuria, positive leukocyte esterase, positive nitrites, or bacteriuria (suggests [amboss.com]

  Midstream specimen of urine for microscopy (pyuria suggests infection), culture and sensitivities. Blood for FBC, CRP, renal function, electrolytes, calcium, phosphate and urate, creatinine. [patient.info]

  He is of feeble health usually or disabled for active labor, has backache or constant pain and hematuria or pyuria. [henriettes-herb.com]

  Pyuria with or without bacteria may be present. Pyuria suggests infection, particularly if combined with suggestive clinical findings, such as foul-smelling urine or a fever. [msdmanuals.com]

• Calcium Increased

  Urinary factors are: increased Calcium. Increased oxalate. Increased urate. Decreased citrate. Decreased Magnesium. Increased pH. Decreased volume. Metabolic abnormalities are: Milk-alkali syndrome. Renal tubular acidosis. [labpedia.net]

• Pseudomonas

  He continued to suffer from repeated episodes of urinary tract infection with Proteus, Providencia, and Pseudomonas species, and he was treated with antibiotics. [ncbi.nlm.nih.gov]

  Can be primary cause or associated with underlying metabolic or structural abnormalities Bacteria that produce urease are strongly associated with nephrolithiasis Proteus, Providenxia, Klebsiella, Pseudomonas, enterococci Predispose to struvite stones [pedclerk.bsd.uchicago.edu]

   They tends to grow in alkaline urine especially with infection caused by urea splitting bacteria (proteus, pseudomonas, staphylococcus).  They are soft stones with smooth surface. [slideshare.net]

  Chronic UTIs with gram-negative rods (Proteus, Pseudomonas,and Klebsiellaspecies) increase risk for struvite stones. Urine pH is greater than 7 in these cases. Uric acid stones are associated with high purine intake or malignancy. [cancertherapyadvisor.com]

  Struvite stones (triple phosphate stones/magnesium ammonium phosphate stones) Etiology Upper UTI with urease-producing bacteria; such as Proteus mirabilis, Klebsiella, and Pseudomonas : can form very large stones that fill the entire renal pelvis and [amboss.com]

[…] of choice for complex renal calculi Staghorn calculi should be treated, and percutaneous nephrolithotomy is the preferred treatment in most patients Ureteroscopy is the preferred treatment in pregnant, morbidly obese, or patients with coagulopathy Most [bmj.com]

After two extracorporeal shock wave lithotripsy treatments disintegration of the stone was not detectable. [ncbi.nlm.nih.gov]

The use of a mobile machine may affect options for emergency treatment, but may also add to waiting times for non-emergency treatment URS for renal and ureteric stones is increasing (there has been a 49% increase from 12,062 treatments in 2009/10, to [gpnotebook.co.uk]

The prognosis for squamous cell carcinoma is poor, but stage for stage the prognosis is not different between patients with urothelial carcinoma and squamous cell carcinoma of the renal pelvis and ureter. [scienceopen.com]

It is clinically important to identify the stone type, which informs prognosis and selection of the optimal preventive regimen. [accessmedicine.mhmedical.com]

If pyelitis or hydronephrosis occur, the prognosis is unfavorable. [henriettes-herb.com]

Median age at diagnosis was significantly lower in the study’s first half (5 vs 10 years; p=0.019) and an infectious etiology was more frequent (p=0.043). [scielo.mec.pt]

Less common stones Calcium phosphate stones Etiology Hyperparathyroidism Type 1 renal tubular acidosis Specific preventive measures Thiazide diuretics Urine acidification Cystine stones Etiology: hereditary defect in renal tubular absorption of dibasic [amboss.com]

No etiological agent for the rapidly recurring concrements could be detected until Ureaplasma urealyticum cultures were performed at the time of the seventh operation. [ncbi.nlm.nih.gov]

Electronic address: [email protected] 2 Division of Urology and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, USA; Division of Urology and Center for Pediatric Clinical [ncbi.nlm.nih.gov]

The project leverages data in the Rochester Epidemiology Project. [mayo.edu]

Epidemiology The incidence of nephrolithiasis in children is lower in children than in adults. [pedclerk.bsd.uchicago.edu]

PATHOPHYSIOLOGY• Slow urine flow, resulting in supersaturation of the urine with the particular element that first become crystallized and later become stone 11. PATHOPHYSIOLOGY• Damage to the lining of the urinary tract 12. [slideshare.net]

We use this case to illustrate the pathophysiology of indinavir stones and hypothesize how they can occur years after discontinuation by discussing the pharmacokinetics of the drug. [ncbi.nlm.nih.gov]

PREVENTION• Low-calcium diets are not generally recommended,except for true absorptive hypercalciuria. [slideshare.net]

This book discusses in further details, the risk factors, treatment options and ways to prevent nephrolithiasis. (Imprint: Nova Biomedical) Preface An Overview of Nephrolithiasis Risk Factors, Prevention and Management (Monica C. Chiang, Taniya N. [novapublishers.com]

Adequate water intake is the most important conservative strategy in urolithiasis prevention; particularly hydropinotherapy with oligomineral water should be considered as an important instrument to prevent stones in subjects predisposed to the disease [ncbi.nlm.nih.gov]

There are a few key issues for the GP: How to manage acute renal colic – who to admit, what analgesia and imaging if not admitting When to refer asymptomatic stones Advice on preventing further calculi, especially for recurrent stone formers Healthcare [primarycareurologysociety.org]

It is clinically important to identify the stone type, which informs prognosis and selection of the optimal preventive regimen. [accessmedicine.mhmedical.com]