Skip to main content
SpringerLink
Log in
Book cover

Clinical Management of Urolithiasis pp 19–27Cite as

Acute Flank Pain

  • Chapter
  • First Online:

  • 1215 Accesses

Abstract

The symptom complex of renal colic is common, and the central feature is flank pain with or without radiation to the groin. Acute ureteral obstruction causes an increase in hydrostatic pressure within the urinary system and is the inciting factor in the generation of acute flank pain of renal origin. The differential diagnosis for acute flank pain is broad and includes both urologic and non-urologic entities, with gastrointestinal, vascular, and gynecologic processes accounting for many of the non-urologic causes. The diagnostic workup begins with a complete history and physical exam with appropriate laboratory assessment. Imaging plays a critical role, with computed tomography (CT) serving as the ultimate cornerstone of the diagnostic algorithm. The overarching goal of the workup is to efficiently recognize signs of serious illness (e.g., fever, hypotension, peritonitis) and rapidly intervene to avoid patient morbidity.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Abbreviations

UTUC:

Upper Tract Urothelial Carcinoma

RTA:

Renal Tubular Acidosis

AAA:

Abdominal Aortic Aneurysm

BUN:

Blood Urea Nitrogen

IVU:

Intravenous Urogram

CT:

Computed Tomography

PID:

Pelvic Inflammatory Disease

References

  • Abramson S, Walders N et al (2000) Impact in the emergency department of unenhanced CT on diagnostic confidence and therapeutic efficacy in patients with suspected renal colic: a prospective survey. ARRS President’s Award. American Roentgen Ray Society. AJR Am J Roentgenol 175(6):1689–1695

    PubMed  CAS  Google Scholar 

  • Abu-Ghazzeh Y, Abdu-Alro’f S (2000) The role of ultrasound in initial evaluation of renal colic. Saudi J Kidney Dis Transpl 11(2):186–190

    PubMed  CAS  Google Scholar 

  • Ammons WS (1992) Bowditch lecture. Renal afferent inputs to ascending spinal pathways. Am J Physiol 262(2 Pt 2):R165–R176

    PubMed  CAS  Google Scholar 

  • Argyropoulos A, Farmakis A et al (2004) The presence of microscopic hematuria detected by urine dipstick test in the evaluation of patients with renal colic. Urol Res 32(4):294–297

    Article  PubMed  CAS  Google Scholar 

  • Assi Z, Platt JF et al (2000) Sensitivity of CT scout radiography and abdominal radiography for revealing ureteral calculi on helical CT: implications for radiologic follow-up. AJR Am J Roentgenol 175(2):333–337

    PubMed  CAS  Google Scholar 

  • Atan L, Andreoni C et al (2005) High kidney stone risk in men working in steel industry at hot temperatures. Urology 65(5):858–861

    Article  PubMed  Google Scholar 

  • Ather MH, Faizullah K et al (2009) Alternate and incidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain. Urol J 6(1):14–18

    PubMed  Google Scholar 

  • Babaian RJ, Johnson DE (1980) Primary carcinoma of the ureter. J Urol 123(3):357–359

    PubMed  CAS  Google Scholar 

  • Baxmann AC, de Mendonca COG et al (2003) Effect of vitamin C supplements on urinary oxalate and pH in calcium stone-forming patients. Kidney Int 63(3):1066–1071

    Article  PubMed  CAS  Google Scholar 

  • Bird VG, Gomez-Marin O et al (2002) A comparison of unenhanced helical computerized tomography findings and renal obstruction determined by furosemide 99 m technetium mercaptoacetyltriglycine diuretic scintirenography for patients with acute renal colic. J Urol 167(4):1597–1603

    Article  PubMed  Google Scholar 

  • Bove P, Kaplan D et al (1999) Reexamining the value of hematuria testing in patients with acute flank pain. J Urol 162(3 Pt 1):685–687

    Article  PubMed  CAS  Google Scholar 

  • Brown J (2006) Diagnostic and treatment patterns for renal colic in US emergency departments. Int Urol Nephrol 38(1):87–92

    Article  PubMed  CAS  Google Scholar 

  • Burlet G, Judlin P (1994) Acute pelvic pain syndrome. Diagnostic and therapeutic approach in women. Rev Fr Gynecol Obstet 89(11):537–542

    PubMed  CAS  Google Scholar 

  • Burnstock G (2009) Purinergic mechanosensory transduction and visceral pain. Mol Pain 5:69

    Article  PubMed  Google Scholar 

  • Chen JH, Chern CH et al (2005) Left flank pain as the sole manifestation of acute pancreatitis: a report of a case with an initial misdiagnosis. Emerg Med J 22(6):452–453

    PubMed  Google Scholar 

  • Chen MY, Zagoria RJ et al (1997) Radiologic findings in acute urinary tract obstruction. J Emerg Med 15(3):339–343

    Article  PubMed  CAS  Google Scholar 

  • Clark AJ, Norman RW (1998) “Mirror pain” as an unusual presentation of renal colic. Urology 51(1):116–118

    Article  PubMed  CAS  Google Scholar 

  • Curhan GC, Willett WC et al (1996) A prospective study of the intake of vitamins C and B6, and the risk of kidney stones in men. J Urol 155(6):1847–1851

    Article  PubMed  CAS  Google Scholar 

  • Curhan GC, Willett WC et al (1999) Intake of vitamins B6 and C and the risk of kidney stones in women. J Am Soc Nephrol 10(4):840–845

    PubMed  CAS  Google Scholar 

  • Eckford SD, Gillatt DA (1992) Abdominal aortic aneurysms presenting as renal colic. Br J Urol 70(5):496–498

    PubMed  CAS  Google Scholar 

  • Fontana D, Randone DF et al (1987) Renal colic: symptoms manifesting an aorto-iliac aneurysm. Clinical case. Minerva Urol Nefrol 39(4):319–323

    PubMed  CAS  Google Scholar 

  • Gault MH, Campbell NR et al (1988) Spurious stones. Nephron 48(4):274–279

    Article  PubMed  CAS  Google Scholar 

  • Harrow BR (1966) Spontaneous urinary extravasation associated with renal colic causing a perinephric abscess. Am J Roentgenol Radium Ther Nucl Med 98(1):47–53

    PubMed  CAS  Google Scholar 

  • Huang CY, Chen CC et al (2008) Ovarian torsion caused by teratoma masquerading as renal colic. Emerg Med J 25(3):182

    Article  PubMed  Google Scholar 

  • Jackman SV, Potter SR et al (2000) Plain abdominal x-ray versus computerized tomography screening: sensitivity for stone localization after nonenhanced spiral computerized tomography. J Urol 164(2):308–310

    Article  PubMed  CAS  Google Scholar 

  • Katz DS, Scheer M et al (2000) Alternative or additional diagnoses on unenhanced helical computed tomography for suspected renal colic: experience with 1000 consecutive examinations. Urology 56(1):53–57

    Article  PubMed  CAS  Google Scholar 

  • Kramer HM, Curhan G (2002) The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988–1994. Am J Kidney Dis 40(1):37–42

    Article  PubMed  Google Scholar 

  • Lazarou S, Fischer MA et al (2002) Renal colic and torsion: case report and review. Can J Urol 9(6):1702–1703

    PubMed  Google Scholar 

  • Li J, Kennedy D et al (2001) Absent hematuria and expensive computerized tomography: case characteristics of emergency urolithiasis. J Urol 165(3):782–784

    Article  PubMed  CAS  Google Scholar 

  • Luchs JS, Katz DS et al (2002) Utility of hematuria testing in patients with suspected renal colic: correlation with unenhanced helical CT results. Urology 59(6):839–842

    Article  PubMed  Google Scholar 

  • Marston WA, Ahlquist R et al (1992) Misdiagnosis of ruptured abdominal aortic aneurysms. J Vasc Surg 16(1):17–22

    Article  PubMed  CAS  Google Scholar 

  • McCarron JP, Mills C et al (1983) Tumors of the renal pelvis and ureter: current concepts and management. Semin Urol 1(1):75–81

    PubMed  CAS  Google Scholar 

  • Melamed MR, Reuter VE (1993) Pathology and staging of urothelial tumors of the kidney and ureter. Urol Clin North Am 20(2):333–347

    PubMed  CAS  Google Scholar 

  • Miller OF, Rineer SK et al (1998) Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain. Urology 52(6):982–987

    Article  PubMed  CAS  Google Scholar 

  • Moldwin R (1987) When renal colic is really malingering. Postgrad Med 82(7):49–52

    PubMed  CAS  Google Scholar 

  • Mutgi A, Williams JW et al (1991) Renal colic. Utility of the plain abdominal roentgenogram. Arch Intern Med 151(8):1589–1592

    Article  PubMed  CAS  Google Scholar 

  • Ong AM, Jarrett TW (2007) Treatment of acute renal colic. In: Stoller ML, Meng MV (eds) Urinary stone disease: the practical guide to medical and surgical management. Humana Press, Totowa

    Google Scholar 

  • Paajanen H, Kettunen J et al (1993) Spontaneous peripelvic extravasation of urine as a cause of acute abdomen. Scand J Urol Nephrol 27(3):333–336

    Article  PubMed  CAS  Google Scholar 

  • Pak CY, Peterson R et al (2001) Adequacy of a single stone risk analysis in the medical evaluation of urolithiasis. J Urol 165(2):378–381

    Article  PubMed  CAS  Google Scholar 

  • Pak CY, Sakhaee K et al (2003) Biochemical profile of stone-forming patients with diabetes mellitus. Urology 61(3):523–527

    Article  PubMed  Google Scholar 

  • Parks JH, Worcester EM et al (2003) Urine stone risk factors in nephrolithiasis patients with and without bowel disease. Kidney Int 63(1):255–265

    Article  PubMed  Google Scholar 

  • Pearle MS (2008) Management of the acute stone event. AUA Update Series 27(30):282–291

    Google Scholar 

  • Power RE, Winter DC et al (2001) A near fatal case of renal colic. J Urol 165(6 Pt 1):1987

    PubMed  CAS  Google Scholar 

  • Press SM, Smith AD (1995) Incidence of negative hematuria in patients with acute urinary lithiasis presenting to the emergency room with flank pain. Urology 45(5):753–757

    Article  PubMed  CAS  Google Scholar 

  • Reich JD, Hanno PM (1997) Factitious renal colic. Urology 50(6):858–862

    Article  PubMed  CAS  Google Scholar 

  • Rekant EM, Gibert CL et al (2001) Emergency department time for evaluation of patients discharged with a diagnosis of renal colic: unenhanced helical computed tomography versus intravenous urography. J Emerg Med 21(4):371–374

    Article  PubMed  CAS  Google Scholar 

  • Richie J (1988) Management of ureteral tumors. In: Skinner DG, deKernion J (eds) Genitourinary cancer. WB Saunders, Philadelphia, pp 323–336

    Google Scholar 

  • Rucker CM, Menias CO et al (2004) Mimics of renal colic: alternative diagnoses at unenhanced helical CT. Radiographics 24(Suppl 1):S11–S28; discussion S28–33

    Article  PubMed  Google Scholar 

  • Sfakianakis GN, Cohen DJ et al (2000) MAG3-F0 scintigraphy in decision making for emergency intervention in renal colic after helical CT positive for a urolith. J Nucl Med 41(11):1813–1822

    PubMed  CAS  Google Scholar 

  • Smith RC, Rosenfield AT et al (1995) Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology 194(3):789–794

    PubMed  CAS  Google Scholar 

  • Stewart DP, Kowalski R et al (1990) Microscopic hematuria and calculus-related ureteral obstruction. J Emerg Med 8(6):693–695

    Article  PubMed  CAS  Google Scholar 

  • Traxer O, Huet B et al (2003) Effect of ascorbic acid consumption on urinary stone risk factors. J Urol 170(2 Pt 1):397–401

    Article  PubMed  CAS  Google Scholar 

  • Trinchieri A, Mandressi A et al (1991) The influence of diet on urinary risk factors for stones in healthy subjects and idiopathic renal calcium stone formers. Br J Urol 67(3):230–236

    Article  PubMed  CAS  Google Scholar 

  • Trinchieri A, Ostini F et al (1998) Hyperoxaluria in patients with idiopathic calcium nephrolithiasis. J Nephrol 11(Suppl 1):70–72

    PubMed  Google Scholar 

  • Urivetzky M, Kessaris D et al (1992) Ascorbic acid overdosing: a risk factor for calcium oxalate nephrolithiasis. J Urol 147(5):1215–1218

    PubMed  CAS  Google Scholar 

  • Vujovic A, Keoghane S (2007) Management of renal stone disease in obese patients. Nat Clin Pract Urol 4(12):671–676

    Article  PubMed  Google Scholar 

  • Weaver DF (1983) Ascorbic acid in nephrolithiasis: culprit or cure? Postgrad Med 73(5):63–66

    PubMed  CAS  Google Scholar 

  • Williams R (1991) Renal, perirenal, and ureteral neoplasms. In: Gillenwater J, Grayhack J, Howards S, Duckett J (eds) Adult and pediatric urology. Mosby-Year Book, St. Louis

    Google Scholar 

  • Wolf JS, Howes DS et al (2012) Nephrolithiasis. http://emedicine.medscope.com/article/437096. Accessed 4 Jan 2012

  • Yilmaz S, Pekdemir M et al (2012) A multicenter case–control study of diagnostic tests for urinary tract infection in the presence of urolithiasis. Urol Res 40(1):61–65

    Article  PubMed  CAS  Google Scholar 

  • Zagoria RJ, Khatod EG et al (2001) Abdominal radiography after CT reveals urinary calculi: a method to predict usefulness of abdominal radiography on the basis of size and CT attenuation of calculi. AJR Am J Roentgenol 176(5):1117–1122

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urology, The Penn State Milton S. Hershey Medical Center, 500 University Drive C483013, Hershey, PA, 17033, USA

    Christopher Rippel M.D. & Jay D. Raman M.D.

Authors
  1. Christopher Rippel M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jay D. Raman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jay D. Raman M.D. .

Editor information

Editors and Affiliations

  1. Klinik für Urologie, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, Sindelfingen, 71065, Baden-Württemberg, Germany

    Thomas Knoll

  2. Center, Department of Urology, UT Southwestern Medical, 5323 Harry Hines, Blvd, Dallas, 75390, Texas, USA

    Margaret S. Pearle

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Rippel, C., Raman, J.D. (2013). Acute Flank Pain. In: Knoll, T., Pearle, M. (eds) Clinical Management of Urolithiasis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28732-9_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-28732-9_3

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-28731-2

  • Online ISBN: 978-3-642-28732-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation