Kidney Stone

Pain from kidney stone passing: (Nephrolithiasis)

  • Acute onset of flank pain radiating to the groin combined with hematuria is highly indicative of nephrolithiasis.
  • Order UA – look for blood.
  • NSAIDs (Ibuprofen) are more effective and better tolerated than opiates for pain control.
    • Toradol (Ketorolac) 10-30mg IV/IM X 1 dose (acutely in the ER)
    • Morphine 2mg IV X 1 dose (acutely in the ER)
      • May want to prescribe Lortab 5 (10 tablets total) if pt in severe pain.
  • Zofran/Phenergan to control nausea if present
  • Flomax (tamsulosin) 0.4mg PO qd alpha-1 antagonists and/or calcium channel blockers increase the rate of spontaneous stone passage (relax ureter, increases urinary flow rate)
  • Encouraged to drink plenty of water.
    1. Encouraged to drink lemonade: to maintain acidity of the urine to prevent stone formation.
    2. Encouraged to take TUMS: to prevent Calcium oxalate stones which are common.
  • If outpatient: Consider recommending patient urinate through a coffee filter to catch the stone: verify that it has passed as well as be able to bring the stone in for analysis (determine why stone developed and how to prevent future stones).
  • The reference standard to confirm nephrolithiasis is the ***noncontrast helical CT scan***, although renal ultrasound is accurate and has less radiation exposure.
  • Stones less than 5 mm have a 90% rate of passing spontaneously, and most can be managed conservatively.
  • Extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy are options for stones not passing after 3 to 4 weeks and when there are unrelenting symptoms or signs of infection or sepsis.

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