History and exam
Key diagnostic factors
common
acute, severe flank pain
Classical renal colic is described as severe, acute flank pain that radiates to the ipsilateral groin. However, cases may have no radiation and some stones are asymptomatic.
Other diagnostic factors
common
previous episodes of nephrolithiasis
nausea and vomiting
Commonly associated with acute episode.
urinary frequency/urgency
As stones pass and get lodged in the distal ureter or intramural tunnel, this can lead to bladder irritation manifested as urinary frequency or urgency.
hematuria
testicular pain
As stones pass through the ureter, flank pain can radiate toward the groin and testicle, leading to testicular pain.
obesity
Increased incidence of renal stones is correlated with increased body mass index (BMI) for both sexes.
uncommon
family history of nephrolithiasis
May be positive for nephrolithiasis in first-degree relatives. If so, this could suggest an underlying metabolic abnormality.
precipitant medications
Potential medications that can play a role in formation of renal stones include antacids, carbonic anhydrase inhibitors, sodium- and calcium-containing medications, vitamins C and D, and protease inhibitors.[38]
groin pain
As stones pass through the ureter, flank pain can radiate toward the groin.
fever
If also associated with urinary obstruction, urgent decompression is needed. May be a sign of struvite stones, which most commonly occur in association with a urinary infection.
tachycardia
May indicate urosepsis.
hypotension
May indicate urosepsis.
costovertebral angle and ipsilateral flank tenderness
May be pronounced in acute renal colic.
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