08.19.2018 - By Zack Olson, MD and Michael Estephan, MD
Kidney Stones are a Diagnosis of Exclusion!!!
Step 1: Consider the Differential Diagnosis for Flank Pain
* Appendicitis* Abdominal Aortic Aneurysm* Ectopic Pregnancy* Testicular/Ovarian Torsion* Kidney Stone
Step 2: Diagnose the Kidney Stone
* Option 1- Renal Ultrasound* Findings consistent with kidney stone diagnosis* Hydronephrosis* Lack of ureteral jets (in bladder)* Kidney stones (poor sensitivity for this)* Benefits* Can be performed at bedside* No radiation* Option 2- Non-contrast CT scan* Great for identifying alternative diagnoses
Step 3: Rule Out Infection
* Fevers* Urinalysis with nitrites or bacteria* If present, patient needs antibiotics
Step 4: Control Symptoms
* Analgesics* NSAIDS (such as ketorolac)* Opiates* Antiemetics* Zofran
Step 5: Rule Out Kidney Injury
* Elevated creatinine* Solitary kidney
Admission Criteria for Kidney Stones
* Coexisting Urinary Tract Infection* Unable to Control Symptoms* Renal Injury/Solitary Kidney
Additional Reading
* How to Interpret a Urinalysis (EM Clerkship)