Flank Pain and Kidney Stones

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)