Kidney stone differential diagnosis

Kidney stone Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Kidney stone from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Ultrasonography
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Kidney stone differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Kidney stone differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
National Guidelines Clearinghouse
NICE Guidance
FDA on Kidney stone differential diagnosis
CDC on Kidney stone differential diagnosis
Kidney stone differential diagnosis in the news
Blogs onKidney stone differential diagnosis
Directions to Hospitals Treating Kidney stone
Risk calculators and risk factors for Kidney stone differential diagnosis

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	Hypertension	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	Abnormal 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	+	+	Flank pain	+	+	-	+	-	-	-	-	-	-	-	Leukocytosis	Red blood cells Proteinuria			-	-				-
	Renal papillary necrosis	Analgesic use (Phenacetin, acetaminophen, NSAIDs) Pyelonephritis Urinary tract obstruction Sickle cell disease Tuberculosis Cirrhosis Diabetes Vasculitis Renal vein thrombosis	-	+ (microscopic)	Flank pain	+	+/-	-	+	-	-	-	+	-	-	-		Bacteriuria Pyuria Microscopic hematuria			-	-	-	-	Blunted renal calyces Contrast material–filled clefts in the renal medulla Non-enhanced lesions surrounded by rings of excreted contrast material Hyperattenuated medullary calcifications	-
	Renal cell carcinoma	Weight loss History of smoking Obesity Von-Hippel Lindau disease Night sweats Malaise Flank mass	+	+ (microscopic)	Flank pain	-	-	-	+	+	+/-	-	-	-	-	-	Anemia	Microscopic hemeturia Renal cell casts Urinary aquaporin-1 (AQP1) and adipophilin (ADFP)- proximal renal tubular cancer			-	-	+/-	-	Non-contrast CT: Lesions are soft tissue attenuation  Areas of calcification and necrosis Contrast-enhanced: Homogenous (small lesions) to irregular (large lesions) contrast enhancement	-
	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