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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