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Diagnosis Show Comments PDF Print E-mail
  

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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