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INTRODUCTION

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The acute phenomenon of renal stones migrating down the ureter is referred to as renal colic. Adults and children can develop kidney stones. In adults, the condition is more common in males than in females; kidney stones usually occur in the third to fifth decade of life. There is a reoccurrence rate of 37% within the first year of having a stone. Children under the age of 16 years constitute 7% of cases seen, with the distribution being equal between the sexes.

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CLINICAL FEATURES

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Patients usually present with an acute onset of severe pain, which may be associated with nausea, vomiting, and diaphoresis. Patients are frequently anxious, pacing, or writhing and are unable to hold still or converse. The pain is sharp and episodic in nature due to the intermittent obstruction of the ureter and is relieved after the stone passes. The pain typically originates in either flank with subsequent radiation around the abdomen toward the groin. However, as the stone passes into the distal ureter, where 75% of stones are diagnosed, the pain may be located in the anterior abdominal or suprapubic area. Vesicular stones may present with intermittent dysuria and terminal hematuria. Children may present in a similar fashion, but up to 30% have only painless hematuria. Vital signs may demonstrate tachycardia and an elevated blood pressure, which are secondary to pain. Fever may be present if there is a concomitant urinary tract infection. Examination may show costovertebral tenderness or abdominal tenderness, guarding, or rigidity. Hematuria may be present in 85% of patients with renal colic.

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DIAGNOSIS AND DIFFERENTIAL

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The consideration of urologic stones and renal colic is based on clinical judgment. The differential diagnosis includes abdominal aortic aneurysm and aortic dissection. Other concerning possibilities include appendicitis, mesenteric ischemia, cholecystitis, ectopic pregnancy, gonadal torsion, renal infarction, incarcerated hernia, epididymitis, salpingitis, pyelonephritis, herpes zoster, drug-seeking behavior, musculoskeletal strain, and papillary necrosis. Papillary necrosis may be present in patients with sickle cell disease, diabetes, nonsteroidal analgesic abuse, or infection. Patients receiving outpatient extracorporeal shock wave lithotripsy for urolithiasis may present to the emergency department (ED) with renal colic because the resulting “sludge” is passed in the urine.

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Obtain a urinalysis to assess for hematuria and infection. Check serum renal function, as a majority of patients who are stone formers have decreased creatinine clearance. Get a pregnancy test in females of childbearing age.

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The recommendation for the ideal modality of imaging is evolving. Imaging helps diagnose a ureteral stone, rules out other diagnoses, identifies complications, establishes the location of the stone, and/or assists with the management if the stone fails to pass spontaneously. Noncontrast helical computed tomography (CT) has the overall highest sensitivity and specificity. Positive findings include changes in the ureteral caliber, suspicious calcifications, stranding of perinephric fat, and dilation of the collecting system. It has a PPV of 96% and a ...

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