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)