Your patient has complaints of severe right-sided flank pain, nausea, vomiting, and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi?
A. Pain radiating to the right upper quadrant.
B. History of mild flu symptoms last week.
C. Dark-colored coffee-ground emesis.
D. Dark, scanty urine output.
Correct Answer: A. Pain radiating to the right upper quadrant.
Patients with renal calculi will most likely report acute, severe flank pain that will often radiate to the abdomen and especially to the groin, testicle, and labia. It is often sharp and severe in nature. It may also be colicky. The pain is often associated with nausea and vomiting which is due to the embryological origins of the urogenital tract.
Option B: If infected, patients may also present with fever, chills, or other systemic signs of infection. This condition, called pyonephrosis or obstructive pyelonephritis, is potentially severe and life-threatening, requiring emergency decompression surgery.
Option C: Patients often present with hematuria as 85% of patients demonstrate at least microscopic hematuria on urinalysis. The physical exam may reveal costovertebral tenderness and hypoactive bowel sounds. The testis and pubic area may also be tender to touch. Fever is rarely seen in renal colic but the presence of fever, pyuria, and leukocytosis may be indicative of pyelonephritis.
Option D: Patients with renal calculi commonly have blood in the urine caused by the stone’s passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant. Renal calculi are a common cause of blood in the urine (hematuria) and pain in the abdomen, flank, or groin. They occur in one in 11 people at some time in their lifetimes with men affected 2 to 1 over women.
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