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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