Urolithiasis - Revision history

Danbot: Strip excess bold

2026-03-22T09:36:56Z

Strip excess bold

← Revisión anterior		Revisión del 09:36 22 mar 2026
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	==Background==		==Background==
	[[File:Urinary system.png\|thumb\|~~'''~~(1) Human urinary system:~~'''~~ (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra. <Br>~~'''~~Additional structures:~~'''~~ (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.]]		[[File:Urinary system.png\|thumb\|(1) Human urinary system: (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra. <Br>Additional structures: (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.]]
	*Urolithiasis comprises 3 similar clinical entities:		*Urolithiasis comprises 3 similar clinical entities:
	**Nephrolithiasis		**Nephrolithiasis
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	**The absence of pyuria cannot exclude a complicating UTI (sensitivity 86%; specificity 79%)<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>		**The absence of pyuria cannot exclude a complicating UTI (sensitivity 86%; specificity 79%)<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>
	*Urine culture :		*Urine culture :
	**Consider for all patients<ref name="a"/> ~~'''~~OR~~'''~~ those at higher risk (female, pyuria, or [[cystitis]] symptoms)<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>		**Consider for all patients<ref name="a"/> OR those at higher risk (female, pyuria, or [[cystitis]] symptoms)<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>
	*Urine pregnancy		*Urine pregnancy
	*Chemistry		*Chemistry
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	**Note: Hydronephrosis, hydroureter, hydrocalyx alone indicate obstructive uropathy, stone must be seen or collected (if passed) in order to diagnose nephrolithiasis as the etiology.		**Note: Hydronephrosis, hydroureter, hydrocalyx alone indicate obstructive uropathy, stone must be seen or collected (if passed) in order to diagnose nephrolithiasis as the etiology.
	**Perinephric Stranding		**Perinephric Stranding
	**~~'''~~Location Landmarks~~'''~~		**Location Landmarks
	***Renal: Does not cause pain, and usually considered an incidental finding		***Renal: Does not cause pain, and usually considered an incidental finding
	***UPJ: Ureteropelvic Junction		***UPJ: Ureteropelvic Junction
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	==Disposition==		==Disposition==
	===Admission===		===Admission===
	~~'''~~Recommended for any of the following:~~'''~~		Recommended for any of the following:
	*Intractable pain or vomiting<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>		*Intractable pain or vomiting<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>
	*Proximal [[urinary tract infection]],<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref> as evidence by:		*Proximal [[urinary tract infection]],<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref> as evidence by:
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	***[[Fever]]		***[[Fever]]
	***Hypotension		***Hypotension
	***Ill appearance, ~~'''~~OR~~'''~~		***Ill appearance, OR
	***Markedly elevated WBC		***Markedly elevated WBC
	***Elevated serum lactate		***Elevated serum lactate
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	*[[Hypercalcemic Crisis]]		*[[Hypercalcemic Crisis]]

	~~'''~~Also consider admission for patients with:~~'''~~		Also consider admission for patients with:
	*Solitary kidney or transplanted kidney without obstruction		*Solitary kidney or transplanted kidney without obstruction
	*Urinary extravasation		*Urinary extravasation

Danbot: Add MedicationDose entries (ketorolac, ibuprofen, tamsulosin) with SMW annotations

2026-03-20T18:25:51Z

Add MedicationDose entries (ketorolac, ibuprofen, tamsulosin) with SMW annotations

@@ Línea 178: / Línea 178: @@
 *Increasing or unremitting colic
 *Staghorn calculi
 ==Disposition==

Moomoodoctor: /* Discharge */

2024-05-22T03:48:01Z

Discharge

← Revisión anterior		Revisión del 03:48 22 may 2024
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	===Discharge===		===Discharge===
	*Small stone, adequate analgesia, able to arrange urology follow up within 7d		*Small stone in patient with adequate analgesia and able to arrange urology follow up within 7d

	==See Also==		==See Also==

Moomoodoctor: /* Admission */

2024-05-22T03:46:20Z

Admission

← Revisión anterior		Revisión del 03:46 22 may 2024
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	*Intractable pain or vomiting<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>		*Intractable pain or vomiting<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>
	*Proximal [[urinary tract infection]],<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref> as evidence by:		*Proximal [[urinary tract infection]],<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref> as evidence by:
	*[[Urosepsis]]:		**[[Urosepsis]]:
	**[[Fever]]		***[[Fever]]
	**Ill appearance, '''OR'''		***Hypotension
	**Markedly elevated WBC		***Ill appearance, '''OR'''
			***Markedly elevated WBC
			***Elevated serum lactate
	*Single or transplanted kidney with obstruction<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>		*Single or transplanted kidney with obstruction<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>
	*Acute renal failure<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>		*Acute renal failure<ref name="Wang RC">Wang RC. Managing Urolithiasis. Annals of EM. April 2016. 67(4):449-454</ref>

Moomoodoctor: /* Pain */

2024-05-22T03:42:19Z

Pain

← Revisión anterior		Revisión del 03:42 22 may 2024
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	**Avoid high dose NSAIDS in patients with renal failure or insufficiency.		**Avoid high dose NSAIDS in patients with renal failure or insufficiency.
	**Ketorolac 15 mg has similar effects to the traditional 30 mg dosage. <ref> Motov S, et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2017 Aug;70(2):177-184. doi: 10.1016 </ref>		**Ketorolac 15 mg has similar effects to the traditional 30 mg dosage. <ref> Motov S, et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2017 Aug;70(2):177-184. doi: 10.1016 </ref>
	*[[Morphine]] or other [[Opioids]] ~~may be needed if severe~~ pain		*[[Morphine]] or other [[Opioids]]
			**Severe pain not controlled with NSAIDS
			**Contraindications to NSAIDS
			**eGFR <30 mL/min

	===Antiemetic===		===Antiemetic===

Moomoodoctor: /* Risk Factors for Complications */

2024-05-22T03:31:12Z

Risk Factors for Complications

← Revisión anterior		Revisión del 03:31 22 may 2024
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	**[[DM]]		**[[DM]]
	**[[Hypertension ]]		**[[Hypertension ]]
			**[[HIV]]
	**Renal insufficiency		**Renal insufficiency
	**Single kidney		**Single kidney
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	**Systemic illness		**Systemic illness
	**[[UTI]]		**[[UTI]]
			*Immunosuppression
			**[[DM]]
			**[[AIDS]]
			**[[Chemotherapy]]

	==Clinical Features==		==Clinical Features==

Moomoodoctor at 03:22, 22 May 2024

2024-05-22T03:22:40Z

← Revisión anterior		Revisión del 03:22 22 may 2024
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	*The remainder		*The remainder
	**Struvite (magnesium ammonium phosphate)		**Struvite (magnesium ammonium phosphate)
	***Associated with infection with urease-producing bacteria such as [[Proteus]], [[klebsiella]], [[pseudomonas]], [[staph]]		***Associated with infection with urease-producing bacteria such as [[Proteus]], [[klebsiella]], [[pseudomonas]], [[staph]],[[Providentia stuartii]], [[Serratia]], and [[Morganella morganii]]
	**Uric Acid		**Uric Acid
	***25% of patients with [[gout]] develop kidney stones		***25% of patients with [[gout]] develop kidney stones

Moomoodoctor: /* Background */

2024-05-22T03:17:15Z

Background

← Revisión anterior		Revisión del 03:17 22 may 2024
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	**Cystolithiasis		**Cystolithiasis

	*The most common cause is infection of residual bladder urine with urea-splitting organisms ([[Proteus]], [[Pseudomonas]], [[Klebsiella]], [[Staphylococcus]] and [[~~Mycoplasma~~]])		*The most common cause is infection of residual bladder urine with urea-splitting organisms ([[Proteus]], [[Pseudomonas]], [[Klebsiella]], [[Staphylococcus]],[[Mycoplasma]], [[Providentia stuartii]], [[Serratia]], and [[Morganella morganii]])

	*Promoters of stone formation <ref> Wang Z, Zhang Y, Zhang J, Deng Q, Liang H. Recent advances on the mechanisms of kidney stone formation (Review). Int J Mol Med. 2021 Aug;48(2):149. doi: 10.3892/ijmm.2021.4982. Epub 2021 Jun 16. PMID: 34132361; PMCID: PMC8208620.</ref>		*Promoters of stone formation <ref> Wang Z, Zhang Y, Zhang J, Deng Q, Liang H. Recent advances on the mechanisms of kidney stone formation (Review). Int J Mol Med. 2021 Aug;48(2):149. doi: 10.3892/ijmm.2021.4982. Epub 2021 Jun 16. PMID: 34132361; PMCID: PMC8208620.</ref>

Moomoodoctor: /* Renal damage */

2024-05-22T03:15:13Z

Renal damage

← Revisión anterior		Revisión del 03:15 22 may 2024
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	*Irreversible renal damage can occur within 3 weeks in patients with a complete obstruction		*Irreversible renal damage can occur within 3 weeks in patients with a complete obstruction
	*Most have no rise in creatinine because unobstructed kidney functions at up to 185% of its baseline capacity		*Most have no rise in creatinine because unobstructed kidney functions at up to 185% of its baseline capacity

			===Epidemiology===
			*1-15% lifetime incidence
			*More common in males
			*50% recurrence rate within 5-10 years
			*More common in hot dry climates

	===Infection===		===Infection===

Moomoodoctor: /* Background */

2024-05-22T03:10:20Z

Background

← Revisión anterior		Revisión del 03:10 22 may 2024
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	*The most common cause is infection of residual bladder urine with urea-splitting organisms ([[Proteus]], [[Pseudomonas]], [[Klebsiella]], [[Staphylococcus]] and [[Mycoplasma]])		*The most common cause is infection of residual bladder urine with urea-splitting organisms ([[Proteus]], [[Pseudomonas]], [[Klebsiella]], [[Staphylococcus]] and [[Mycoplasma]])

			*Promoters of stone formation <ref> Wang Z, Zhang Y, Zhang J, Deng Q, Liang H. Recent advances on the mechanisms of kidney stone formation (Review). Int J Mol Med. 2021 Aug;48(2):149. doi: 10.3892/ijmm.2021.4982. Epub 2021 Jun 16. PMID: 34132361; PMCID: PMC8208620.</ref>
			**High serum calcium
			**High uric acid and phosphate
			**Urine pH abnormalities, either high or low

			*Inhibitors of stone formation <ref> Wang Z, Zhang Y, Zhang J, Deng Q, Liang H. Recent advances on the mechanisms of kidney stone formation (Review). Int J Mol Med. 2021 Aug;48(2):149. doi: 10.3892/ijmm.2021.4982. Epub 2021 Jun 16. PMID: 34132361; PMCID: PMC8208620.</ref>
			**Citrate
			**Magnesium
			**Various macromolecules

	===Renal damage===		===Renal damage===