From the Guidelines
When evaluating a patient for suspected kidney stones, it is crucial to ask about the nature of their pain, associated symptoms, urinary changes, and past medical history to establish the likelihood of kidney stones versus other conditions with similar presentations. The patient's history should include questions about the location, intensity, and radiation of their pain, as well as the timing and any factors that exacerbate or relieve it 1. Associated symptoms such as nausea, vomiting, fever, and chills should also be queried, as these can indicate the presence of an infection or other complications. Urinary changes, including hematuria, frequency, and urgency, are also important to assess, as these can be indicative of a stone or other urinary tract issue 1. A thorough past medical history, including previous kidney stones, should be obtained, as well as an assessment of risk factors such as family history, low fluid intake, high-sodium or high-protein diet, and certain medical conditions like gout or inflammatory bowel disease. The patient's medication use, particularly calcium supplements, vitamin C, or certain diuretics, should also be determined, as these can increase the risk of stone formation. Additionally, the patient should be asked if they have noticed any visible blood in their urine or passed any stones, as this can help confirm the diagnosis. Understanding the patient's hydration habits and diet can also provide insight into potential causes and guide preventive recommendations. A thorough history helps determine appropriate diagnostic testing and immediate management needs, particularly if the patient has signs of infection or complete urinary obstruction requiring urgent intervention, as outlined in the acr appropriateness criteria® acute onset flank pain-suspicion of stone disease (urolithiasis) 1. Some key questions to ask include:
- Can you describe the location and severity of your pain?
- When did your pain start, and has it been constant or intermittent?
- Have you experienced any nausea, vomiting, fever, or chills?
- Have you noticed any blood in your urine or changes in your urinary frequency or urgency?
- Do you have a history of kidney stones or other urinary tract issues?
- What is your typical diet and fluid intake like?
- Are you taking any medications that could increase your risk of stone formation?
From the Research
Diagnostic Questions
To suspect kidney stones, the following questions can be asked:
- Can you describe your pain? Where is it located and how severe is it?
- Have you experienced any nausea or vomiting?
- Have you noticed any changes in your urine, such as blood or an unusual odor?
- Do you have a history of kidney stones or other kidney problems?
- Have you recently had any urinary tract infections?
Medical History
Asking about the patient's medical history can also be helpful, including:
- Do you have a family history of kidney stones?
- Have you had any previous surgeries or medical conditions that may increase your risk of kidney stones?
- Are you taking any medications that may increase your risk of kidney stones? As stated in the study on kidney stones 2, a medical history is essential in screening for the risk of stone recurrence.
Lifestyle Questions
Lifestyle questions can also provide valuable information:
- How much fluid do you typically drink in a day?
- What is your typical diet like?
- Do you have a history of dehydration or limited fluid intake? The study on kidney stones 2 recommends lifestyle modifications, such as increased fluid intake, for all patients with kidney stones.