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Family Medicine

Answer 3
  1. Pain control and hydration. Renal stones generally do not cause symptoms until the stone begins to move down the urinary tract. Nausea results from the obstruction of a hollow viscus. Most symptomatic patients with stones are treated conservatively with pain medication and hydration. The likelihood that stones will pass depends on the size and location of the stone; stones smaller than 5 mm will pass spontaneously in about 90% of patients.1 Patients should be hospitalized if they cannot tolerate oral administration of medication or have severe pain. Patients should strain their urine and bring passed stones to the office for analysis. Patients should consider lowering their sodium and meat intake. Nonsteroidal anti-inflammatory drugs and opioids are typically used in patients with renal colic.2 Extracorporeal shock wave lithotripsy and other surgical options would not be used in this case because the patient is stable. However, if the patient showed signs and symptoms of obstruction or sepsis, surgical intervention would be needed. Urology consultation is needed for patients with acute renal failure, sepsis, anuria, or intractable pain.

    1. Pietrow P, Karellas M. Medical management of common urinary calculi. Am Fam Physician 2006;74:86-94.

    2. Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med 2004;350:684-93.

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