What should I do if I think I have kidney stones?

Evaluation and Management of Suspected Kidney Stones

If you think you have kidney stones, you should seek medical attention for proper diagnosis through urinalysis, serum chemistries, and appropriate imaging studies to guide treatment decisions based on stone type and size. 1, 2

Initial Assessment Questions for Suspected Kidney Stones

• Ask about pain characteristics: location, intensity, radiation (typically severe pain radiating to the groin), timing, and factors that worsen or improve symptoms 1, 3
• Inquire about associated urinary symptoms: hematuria, dysuria, urinary frequency, urgency, or cloudy urine 3
• Check for systemic symptoms: fever, chills, nausea, vomiting (which may indicate infection or high-grade obstruction) 1
• Assess for risk factors:
  • Personal or family history of kidney stones 2
  • Medical conditions: hyperparathyroidism, renal tubular acidosis, inflammatory bowel disease 1
  • Dietary habits: fluid intake, calcium, sodium, protein, and oxalate consumption 1
  • Medications that may increase stone risk 3

Diagnostic Workup

• Urinalysis should include both dipstick and microscopic evaluation to assess:
  • Urine pH (helps determine stone type)
  • Presence of blood (hematuria is common)
  • Signs of infection
  • Crystal identification (may be pathognomonic of stone type) 1, 4
• Serum chemistries should include:
  • Electrolytes
  • Calcium (to rule out hypercalcemia)
  • Creatinine (to assess kidney function)
  • Uric acid 1, 4
• Obtain urine culture if:
  • Urinalysis suggests infection
  • Patient has history of recurrent UTIs 1, 4
• Imaging studies:
  • Ultrasound is recommended as first-line imaging (especially for pregnant patients) 4
  • Non-contrast CT scan if ultrasound is inconclusive (provides detailed information about stone size, location, and density) 4

Immediate Management

• Pain control:
  • NSAIDs are first-line treatment for renal colic (preferably diclofenac) 4
  • Opioids should be considered only when NSAIDs are contraindicated 4
• Increase fluid intake to promote stone passage 1
• Strain urine to catch any passed stones for analysis 4
• Seek immediate medical attention if experiencing:
  • Fever (suggests infection)
  • Intractable pain
  • Inability to keep fluids down
  • Signs of urinary obstruction 4

Follow-up and Prevention

• Stone analysis should be obtained at least once when stone material is available 1, 4
• High-risk or recurrent stone formers should undergo metabolic testing:
  • 24-hour urine collection analyzing volume, pH, calcium, oxalate, uric acid, citrate, sodium, potassium, and creatinine 1, 4
• Prevention strategies include:
  • Increase fluid intake to achieve urine volume of at least 2.5 liters daily 1
  • Dietary modifications based on stone type:
    • For calcium oxalate stones: maintain normal calcium intake, limit sodium and oxalate-rich foods 1
    • For uric acid stones: alkalinize urine with potassium citrate 1, 5
    • For cystine stones: limit sodium and protein intake 1
  • Medications based on stone type and metabolic abnormalities:
    • Thiazide diuretics for hypercalciuria 1
    • Potassium citrate for hypocitraturia or uric acid stones 1, 5
    • Allopurinol for hyperuricosuria with calcium oxalate stones 1

When to Seek Emergency Care

• Fever or signs of infection with suspected kidney stone (urologic emergency) 1
• Severe, uncontrolled pain 4
• Vomiting leading to dehydration 4
• Known solitary kidney with signs of obstruction 4
• Bilateral obstruction or acute kidney injury 4

By following this approach, you can receive appropriate diagnosis and treatment for kidney stones while taking steps to prevent future episodes.