Kidney stone differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating Nephrolithiasis from other Diseases

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuriua, nausea and vomiting. The differentials include the following:

Category	Disease	History	Signs and Symptoms										Physical Examination			Laboratory abnormalities
			Nausea/vomiting	Hematuria	Location of pain	Fever	Tachycardia	Hypotension	Anorexia	Constipation	Rebound tenderness	Urinary frequency/Urgency/Dysuria	Costovetebral angle tenderness	Pelvic Examination	Rectal Examination	Complete Blood Count (CBC)	Urinalysis	BUN	Creatinine	Stone analysis	Urine Beta- hCG	Liver Function tests (LFTs)	Serum Amylase/Lipase	Abdominal CT scan	Serum Parathyroid hormone levels (PTH)
Renal Pathology	Nephrolithiasis	Primary hyper parathyroidism Inadequate dietary calcium intake Hypercalciuria Hyperoxaluria Cystinuria Renal tubular acidosis Infection with urease producing bacteria (Ureaplasma urealyticum, Klebsiella, Protues)	+	+	Flank/back pain radiating to groin	-	+	-	+/-	-	-	+	-	-	-	-					-	-	-	Non-contrast CT scan may show stone as radiolucency	+/-
	Pyelonephritis	Urinary tract infection Immunocompromised state (Diabetes, immunosuppressive medications) Urinary tract obstruction History of pyelonephritis Pregnancy Presence of urinary catheter, stent, nephrostomy tube	+	+ (microscopic)	Costovertebral angle Positive renal punch sign	+	+	+	+/-	-	+	+	+	Uretheritis Vaginitis	-	Leukocytosis	Pyuria Positive leukocyte esterase			-	+/-	-	-	Globaly decreased contrast uptake  Foci from abscess pockets	-
	Renal infarct	Sickle cell disease or trait Thrombosis Trauma Hypertension Cardiac arrhythmia Coagulopathy Atherosclerosis
	Renal papillary necrosis	Analgesic use (Phenacetin, acetaminophen, NSAIDs) Pyelonephritis Urinary tract obstruction Sickle cell disease Tuberculosis Cirrhosis Diabetes Vasculitis Renal vein thrombosis
	Renal cell carcinoma	Weight loss Night sweats Malaise Flank mass
	Uretral stricture	Prior urinary tract surgery Congenital Urinary catheterization Direct penile trauma
Gynecological Pathology	Pelvic inflammatory disease	Endometritis Saplingitis Cesarian section Septic abortion Urinary tract infection Tuberculosis Actinomycosis
	Ovarian torsion	Sudden acute pain Sharp pain aggravated by walking Intermittent/colicky pain
	Ectopic pregnancy	History of previous ectopic pregnancy Tubal surgery Intrauterine device usage History of pelvic surgery History of pelvic inflammatory disease Sub-fertility Sternous excercise Increased maternal age Cigarette smoking
Prostate Pathology	Prostatitis	Bacterial infection by: Ureaplasma urealyticum Proteus Chlamydia Gonorrhea E.Coli Pseudomonas Mycoplasma Prior history of prostatitis Urinary tract infection Urinary catheterization
	Prostatic cancer	Family history of prostate cancer (1st degree relatives) Germline mutation of HOXB13 (G84E variant) Black ethnicity Age > 50 years
Testicular Pathology	Testicular torsion	Age 12 - 16 years Previous history of testicular torsion Family history of testicular torsion Prematurity Undescended testes Low birth weight
	Orchitis	Unprotected sexual intercourse Mumps, coxsackie virus infection Concurrent epididymitis Congenital abnornmalities Prostatitis Prostatic hypertrophy or calculi
Abdominal Pathology	Cholecystitis	Female gender Obesity Pregnancy (increased progesterone promotes biliary stasis) Rapid weight loss Oral contraceptive use Increasing age Total parenteral nutrition
	Appendicitis	Male gender Adolescents Diet low in fiber and high in refined carbohydrates History of appendicitis in first degree relatives
	Diverticulitis	Diverticulosis Low fiber diet Old age
	Abdominal aortic aneurysm	Hypertension Cigarette smoking
	Portal vein thrombosis	Mutated JAK2 V617F Anti-phospholipid syndrome Paroxysmal nocturnal hemoglobinuria Homocysteinuria Factor V Leiden Prothrombin mutation G20210A Protein C or S deficiency Oral contraceptive use Cirrhosis Pregnancy and post-partum
	Duodenal ulcer	Helicobacter pylori infection Tobacco smoking NSAID use EtOH use Older age Female gender Family history of duodenal ulcers
	Ischemic colitis	Age > 60 years Hemodialysis Hypertension Hypoalbuminemia Diabetes mellitus