Kidney stone differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2] Amandeep Singh M.D.[3]

Overview

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuria, nausea and vomiting.

Differentiating Nephrolithiasis from other Diseases

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuria, nausea and vomiting. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]

Category Disease Risk factors Symptoms Signs Paraclinical studies
Pain N/V Anorexia Constipation Urinary symptoms Fever HR BP Tenderness Abdominopelvic exam Rectal exam CBC Urinalysis BUN Cr Urine Beta−hCG LFT Serum amylase & lipase CT
Renal Pathology Nephrolithiasis + ± + Nl Nl Nl Nl Nl Nl Nl Nl
  • Radiolucent stone
Pyelonephritis + ± + +
  • Positive renal punch sign
  • Costovertebral angle tenderness
Nl Nl Nl Might be + Nl Nl
  • Decreased contrast uptake
  • Foci from abscess pockets
Renal infarct + + Nl Nl Nl to ↑ Nl Nl Nl
  • Decreased contrast uptake
Renal papillary necrosis + + ± Nl Nl Nl Nl to ↑ Nl Nl Nl
Renal cell carcinoma + + ±
  • Flank mass
Nl Nl Nl Nl Nl
Urethral stricture + Nl Nl Nl Nl to ↑ Nl Nl Nl Nl
Category Disease Risk factors Pain N/V Anorexia Constipation Urinary symptoms Fever HR BP Tenderness Abdominopelvic exam Rectal exam CBC Urinalysis BUN Cr Urine Beta−hCG LFT Serum amylase & lipase CT
Gynecological pathology Pelvic inflammatory disease
  • Right/left upper quadrant
+ + + + Nl Nl Nl Might be + Nl Nl
Ovarian torsion NA
  • Acute unilateral poorly localized lower abdominal sharp colicky pain aggravated by walking
+ + Nl Nl Nl Nl
  • Twisted and distended ovarian pedicle
  • Enlarged ovary (>4.0 cm)
Ectopic pregnancy + + + + ↓ (if ruptured)
  • Positive abdominal tenderness (if ruptured)
Nl
  • Low platelet distribution width (decreased platelet activation)
  • Monocytosis
+ Might be abnormal Nl NA
Category Disease Risk factors Pain N/V Anorexia Constipation Urinary symptoms Fever HR BP Tenderness Abdominopelvic exam Rectal exam CBC Urinalysis BUN Cr Urine Beta−hCG LFT Serum amylase & lipase CT
Prostate pathology Prostatitis + + + Nl Nl Nl Nl
Prostatic cancer + + Nl Nl Nl Nl Nl Nl Nl
Testicular pathology Testicular torsion + ± ± + Nl Nl Nl Nl Nl Nl Nl
Orchitis + ± + + Nl Nl Nl Nl Nl Nl
Category Disease Risk factors Pain N/V Anorexia Constipation Urinary symptoms Fever HR BP Tenderness Abdominopelvic exam Rectal exam CBC Urinalysis BUN Cr Urine Beta−hCG LFT Serum amylase & lipase CT
Abdominal pathology Cholecystitis + + + + Nl Nl Nl Nl Nl Might be abnormal Might be abnormal
Appendicitis + + ± + + Nl + Nl Nl
  • Leukocytosis
Nl Nl Nl Abnormal (if perforation)
Diverticulitis + + + + + Nl Nl Nl Nl Nl Abnormal (if perforation)
  • Colonic wall thickening
  • Pericolic fat stranding
Abdominal aortic aneurysm + Nl
  • Positive abdominal tenderness (if rupture)
Nl Nl Nl Nl Nl
  • CT scan accurately predict the aneurysmal size
Disease Risk factors Pain N/V Anorexia Constipation Urinary symptoms Fever HR BP Tenderness Abdominopelvic exam Rectal exam CBC Urinalysis BUN Cr Urine Beta−hCG LFT Serum amylase & lipase CT
Portal vein thrombosis + + + + Nl Nl Nl Might be abnormal Abnormal (if bowel infarction, perforation)
  • Hyperdense thrombus on non−contrast CT
  • Non−enhancing defect of bland thrombus on contrast CT
Duodenal ulcer + + + Nl Nl Nl Nl Abnormal (if bowel perforation)
Ischemic colitis + + + + + ↑ or ↓ (if necrosis or sepsis)
  • Positive abdominal tenderness (if transmural necrosis)
Nl Nl to ↑ Nl Nl Abnormal (if bowel perforation)
Category Disease Risk factors Pain N/V Anorexia Constipation Urinary symptoms Fever HR BP Tenderness Abdominopelvic exam Rectal exam CBC Urinalysis BUN Cr Urine Beta−hCG LFT Serum amylase & lipase CT

References

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