© Springer International Publishing Switzerland 2015
Manoj Monga, Kristina L. Penniston and David S. Goldfarb (eds.)Pocket Guide to Kidney Stone Prevention10.1007/978-3-319-11098-1_1616. Acute Renal Colic and Medical Expulsive Therapy
(1)
Division of Urologic Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Suite 1570, White Zone, Durham, NC 27710, USA
Keywords
Renal colicFlank painStone painMETMedical expulsive therapyUrolithiasisNephrolithiasisConservative managementAcute Renal Colic
Defined as a combination of the following: pain of short (≤12 h) duration, nausea/vomiting, flank pain, anorexia, and/or hematuria (≥10,000/mm3 erythrocytes on urinalysis) [1].
Differential Diagnosis
Renal or ureteral stone
Acute uncomplicated pyelonephritis
Signs and symptoms can be extremely similar
If fever ≥38 °C, imaging is mandatory to rule out obstruction
Renal infarction and/or renal vein thrombosis
Have a higher degree of suspicion in patients at increased risk or with a history of thromboembolic disease
Uretero-pelvic junction obstruction
Especially after high volume fluid intake, which increases urine output and can dilate the pelvis causing obstructive pain
Testicular torsion and/or torsion of the appendix testis
Most common in children and early adolescent males
Spontaneous renal hemorrhage
Can be caused by kidney masses (including angiomyolipoma), bleeding diathesis, or occult trauma
Renal papillary necrosis
More common in systemic disease including diabetes mellitus, sickle cell crisis, and analgesic nephropathy
Pain is caused as sloughed papillae obstruct the ureter
Lab work
Complete blood cell count (white cells, red cells, and platelets)
Blood chemistry (creatinine, uric acid, sodium, potassium, ionized calcium)
Urinalysis (including red and white cells, bacteria, nitrite, approximate pH)
If febrile additional testing is warranted
C Reactive Protein
EAU guidelines recommend obtaining CRP in febrile patients to help determine the need for diversion or stent placement. CRP > 28 better predicts a need for urinary diversion than even a leukocytosis or elevation of serum creatinine value [2]
Urine Culture
Coagulation studies (PT/INR and PTT)
Imaging
Patients presenting with flank pain, fever, and a suspected stone should receive prompt imaging. This is particularly true of patients with solitary kidney, and of patients in whom the diagnosis is unclear and imaging would be of assistance.
Non-contrast enhanced computed tomography (NCCT) is the imaging modality of choice to confirm stone diagnosis in patients with acute flank pain [3, 4].
Patients with a BMI of ≤30 should be considered for low-dose NCCT
Digitally enhanced CT is preferred because it allows for 3D reconstruction of the collecting system, as well as easy calculation of skin-to-stone distance and stone density, two important predictors of procedural success rates
NCCT has a sensitivity and specificity of 94–100 %
NCCT also has the benefit of elucidating non-urinary pathology in about 1/3 of patients who present with acute flank painRelated posts:
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