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Renal Calculus

Renal Calculus is a topic covered in the 5-Minute Emergency Consult.

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  • Urinary tract obstruction
  • Intermittent distention of the renal pelvis of proximal ureter produces pain
  • Kidney stones:
    • Most common cause of renal colic
    • Stone composition:
      • 80%: Calcium stones (calcium oxalate > calcium phosphate)
      • 5% uric acid
      • Others: Magnesium ammonium phosphate (struvite), cystine
    • Associated with infections caused by urea-splitting organisms (e.g., Pseudomonas, Proteus, Klebsiella) along with an alkalotic urine
    • 90% of urinary calculi are radiopaque


  • 6–12% lifetime risk in the general population
  • Twice as common in men as women
  • Peak incidence between 40 and 60 yr old
  • Theories on stone formation:
    • Urinary supersaturation of solute followed by crystal precipitation
    • Decrease in the normal urinary proteins inhibiting crystal growth
    • Urinary stasis from a physical anomaly, catheter placement, neurogenic bladder, or the presence of a foreign body
  • Recurrence rate of 40% at 5 yr and 75% at 20 yr
  • Associated with chronic kidney disease, hypertension, type 2 diabetes mellitus, metabolic syndrome, and an increased risk of coronary artery disease

Pediatric Considerations
  • Rare in children
  • When present, often is an indication of a metabolic or genetic disorder
  • 60% present with flank or abdominal pain though up to 30% only present with hematuria
  • Pediatric patients <16 yr comprise ∼7% of all cases of renal stones.
  • 1:1 sex distribution
  • Causes of stone formation:
    • Metabolic abnormalities (50%)
    • Urologic abnormalities (20%)
    • Infection (15%)
    • Immobilization syndrome (5%)

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Rosen, Peter, et al., editors. "Renal Calculus." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307356/all/Renal_Calculus.
Renal Calculus. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307356/all/Renal_Calculus. Accessed April 23, 2019.
Renal Calculus. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307356/all/Renal_Calculus
Renal Calculus [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307356/all/Renal_Calculus.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Renal Calculus ID - 307356 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307356/all/Renal_Calculus PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -