All patients should have a basic work up to rule out systemic causes of nephrolithiasis.
Comprehensive evaluation needs to be done for the following patients:

• All children
• Patients in the demographic group in which stones are not expected
• Patients with growing or recurrent stone (metabolically active disease)
• Patients with a strong family history of stones
• Patients with systemic diseases or underlying metabolic disorders that predispose to stone formation
• When the recovered stone is not composed predominantly of calcium oxalate
• Solitary kidney

A detailed evaluation should be undertaken 3 to 4 weeks after the last episode of renal colic, and as the patients resume their normal fluid and dietary intakes.

Medical History

• Chronology of stone events
• Presence of systemic diseases or underlying metabolic disorders that enhance stone formation
• The presence of a family history of stones
• Intake of medication that can increase the risk of stone formation
• Occupation and life style
• The analysis of previous stones

Physical Examination
May provide clues to underlying systemic causes

Laboratory Tests

• Urinalysis
• Urine culture
• Cystine screening
• Blood tests
• Twenty-four hour urine collection; total urine volume, pH, calcium, citrate, magnesium, oxalate, phosphate, sodium uric acid (cystine, if screening test is positive), and creatinine
• Stone analysis. With x-ray crystallgraphy or infrared spectrography.
• Urinary acidification test

Radiologic Evaluation

• Plain film of the kidneys, ureter, and the bladder (KUB)
• Intravenous pyelogram (IVP)
• Ultrasonographv (US)
• CT scans

Clinical Manifestations of Nephrolithiasis

• Asymptomatic nephrolithiasis may be discovered during the course of radiographic studies undertaken for unrelated reasons
• Pain is the most common symptom; mild ache to severe intense pain requiring hospitalization and parenteral analgesic medications
• Hematuria may be absent if the stone is causing complete obstruction
• Nausea and vomiting are frequently associated with renal colic
• Frequency, urgency, and dysuria can result from stone impaction at the ureterovesical junction and/or associated urinary tract infection
• Low-grade fever without associated infection
• Staghorn calculi do not produce symptoms unless small pieces break off and pass into the ureter. They can cause chronic renal failure over years if present bilaterally

References

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