Colicky versus constant pain, radiation to groin, urinary symptoms, hematuria
Fever/chills, vomiting, anuria, solitary kidney, prior stones/urologic procedures
Pregnancy possibility, anticoagulation, vascular disease, trauma
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← All presentations
Flank Pain & Renal Colic
Confirm the stone—but first exclude infected obstruction, AAA, and the surgical mimics.
Your objective: explain the approach, recognize important warning signs, then test your recall.
Abbreviations explained
- ACS
- Acute coronary syndrome
- OMI
- Occlusion myocardial infarction
- ECG
- Electrocardiogram
- PE
- Pulmonary embolism
- POCUS
- Point-of-care ultrasound
- QTc
- QT interval corrected for heart rate
- LBBB
- Left bundle branch block
- RBBB
- Right bundle branch block
- hs-cTn
- High-sensitivity cardiac troponin
- CTA
- Computed tomography angiography
- ICU
- Intensive care unit
Filter
The jobConfirm the stone—but first exclude infected obstruction, AAA, and the surgical mimics.
- Check vital signs, pregnancy status, urinalysis, renal function, and analgesic response.
- Look for sepsis or obstruction before choosing outpatient stone care.
- Use ultrasound or CT according to risk, first episode, diagnostic uncertainty, pregnancy, and local pathways.
Renal colic is common, but flank pain can be vascular, infectious, gynecologic, gastrointestinal, or spinal.
A stone with sepsis, solitary kidney, anuria, or refractory symptoms is not a routine discharge.
Infected obstructed urinary system Critical
Key: Fever/systemic illness plus obstruction requires urgent urology drainage and antibiotics—not outpatient stone management.
Ruptured AAA / aortic dissection Critical
Key: Older patient, hypotension, vascular risk, abdominal/back pain, or pulse deficit: image the aorta.
Pyelonephritis with sepsis Critical
Key: Fever, flank tenderness, shock, or vomiting warrants sepsis treatment and source-control assessment.
Ectopic pregnancy / ovarian torsion Emergent
Key: Pregnancy test and pelvic consideration remain essential when anatomy and symptoms fit.
Uncomplicated ureteric stone Common
Key: Analgesia, hydration advice, urine straining where used, and follow-up depend on size, location, renal function, and symptoms.
Tick what your patient has — the banner updates as you go.
Vitals and sepsis screen; abdominal, CVA, vascular, and genital/pelvic examination as indicated
Look for peritonism, pulsatile mass, testicular tenderness, or neurologic deficit
Reassess pain and oral tolerance after treatment
Bedside
- Urinalysis, pregnancy test when relevant, creatinine
- POCUS for hydronephrosis and aortic screening when indicated
Imaging
- Low-dose noncontrast CT for uncertain/high-risk cases per local policy
- Ultrasound/MRI pathway in pregnancy or radiation-sensitive patients
Targeted
- CBC/cultures/lactate if febrile or systemically unwell
- Do not rely on hematuria alone to prove or exclude a stone
Medication safety reminder
Use this as a first-pass prompt; verify all medications, doses, concentrations, contraindications, weight, pregnancy status, and local protocols before administration.
Check indication, allergy, route, renal/hepatic risk, interactions, monitoring, and local formulary.
Discharge
- Uncomplicated symptoms controlled orally, no infection/AKI/high-risk anatomy, and clear follow-up.
Admit / urology
- Infection concern, AKI, refractory symptoms, large/complicated stone, or unreliable follow-up.
Urgent drainage / resuscitation
- Septic obstructed system, anuria with obstruction, or vascular catastrophe.
Use objective reassessment and the local pathway.
Before the next decision · reassess and hand over
Use these learning prompts with the presentation’s pathway. They are not discharge criteria.
- Reassess: compare symptoms, observations and examination with the initial assessment and response to treatment.
- Warning signs for Flank Pain & Renal Colic:
- Fever, rigors, hypotension, or toxicity
- Anuria, solitary kidney, acute kidney injury, or bilateral obstruction
- Uncontrolled pain or vomiting
- Older patient with vascular risk or hypotension
- Pregnancy with pain or bleeding
- Reconsider: check unresolved findings and alternative explanations, including the pitfalls below.
- Escalate: communicate deterioration, uncertainty or needs beyond the current setting.
- Plan the transition: identify outstanding results, responsibility for follow-up, patient understanding and specific return advice.
Clinical Pearls
- The emergency is infection plus obstruction, not the stone size alone.
- A first or atypical episode deserves a broader differential.
Pitfalls
- Diagnosing a stone from hematuria alone.
- Discharging a febrile obstructed patient with antibiotics but no drainage plan.
PRACTICE REFRESHER
Rapid recall
Test your first action and the dangerous diagnoses before revealing the answer.
01 · First move
Before you scroll, what needs to happen first?
Check vital signs, pregnancy status, urinalysis, renal function, and analgesic response.
02 · Immediate threats
Name at least two diagnoses that cannot wait.
Infected obstructed urinary system · Ruptured AAA / aortic dissection · Pyelonephritis with sepsis
PRIVATE TO THIS DEVICE
Your learning note
Capture a weak point, a teaching pearl, or a question to take to your next shift.
Review schedule starts when marked reviewed
Selected guidance · source check 2026-09-07. These 1 source links support selected teaching points, not a complete review of this topic. Check population, setting and local protocol before applying a recommendation.
- Rosen’s Emergency Medicine, 10th ed. — renal and genitourinary emergencies
- EAU/AUA urolithiasis guidance; local imaging and urology pathways