Metabolic evaluation and stone composition analysis are recommended for patients with recurrent stones or patients with an initial stone who are at high risk of recurrence, including those with a family history, pediatric patients, and young adult patients. Urinalysis that demonstrates hematuria can also help to confirm the diagnosis if the rest of the clinical picture is consistent with nephrolithiasis.

Criteria for Diagnosisĭiagnosis of nephrolithiasis is confirmed when a stone has passed, has been extracted or destroyed, or has been identified by imaging studies. In younger children, the signs may be more subtle and include irritability and changes in urinary habits. Patients tend to present with pain in the back, abdomen, or groin, nausea and/or vomiting, fever and chills, or other symptoms of a urinary tract infection, including blood in the urine, cloudy urine, a frequent urge or inability to urinate, or pain with urination. Testing should be considered when an individual presents with signs and symptoms of nephrolithiasis, is diagnosed with a kidney stone, or has a recurrence of stones. A stone analysis and evaluation of a 24-hour urine specimen for stone risk can help identify the cause of stone formation and may help prevent recurrence by targeting risk factors. Further testing is recommended after initial stone formation in individuals at high risk for stone recurrence, in patients with recurrent stone formation, and in all children with stones. Initial evaluation for a suspected urinary calculus may involve urinalysis with microscopy and culture, a complete blood count, and a metabolic panel to include kidney function testing. Most small stones are passed spontaneously, but sometimes intervention to break up the stone with a laser or sound waves (lithotripsy) or a more invasive surgical removal is needed. Kidney stones (renal calculi) present with hematuria, flank pain, or back pain, which can occur in other conditions, including infection and obstruction of the genitourinary tract. Nephrolithiasis is on the rise throughout the world, and the estimated lifetime risk of developing nephrolithiasis is 6-12% in individuals in the United States.

Renal calculus