Renal Stone (Urolithiasis)
A 38-year-old male office employee presented with sudden, severe right-sided flank pain that had continued for approximately 8 hours. The pain was intermittent and colicky, radiating towards the groin and accompanied by nausea and two episodes of vomiting. Clinical examination and imaging confirmed a 7-mm right proximal ureteric calculus with mild hydroureteronephrosis. The case highlights the importance of timely diagnosis, appropriate pain management, monitoring for complications and deciding when urological intervention may be required.
Patient Profile
- Age: 38 years
- Sex: Male
- Occupation: Office employee
- Height: 172 cm
- Weight: 78 kg
- BMI: 26.4 kg/m²
- Chief complaint: Severe right-sided flank pain for 8 hours
History of Present Illness
The patient experienced sudden-onset, severe pain in the right flank that radiated towards the groin. The pain was colicky and intermittent in nature. It was associated with nausea and two episodes of vomiting.
He also reported increased urinary frequency but did not have a significant reduction in urine output.
There was no history of fever, chills or previous renal stones.
Clinical Examination
On examination, the patient was haemodynamically stable. His vital signs were:
- Pulse: 88/min
- Blood pressure: 132/84 mmHg
- Temperature: 98.4°F
Right renal angle tenderness was present. The abdomen was soft, with no guarding or rigidity. There was no palpable bladder.
Diagnostic Assessment
Laboratory investigations were performed to assess renal function, infection and metabolic factors.
Investigation | Result |
Haemoglobin | 14.2 g/dL |
WBC count | 8,900/µL |
Serum creatinine | 1.0 mg/dL |
Urea | 28 mg/dL |
Serum calcium | 9.4 mg/dL |
Uric acid | 6.1 mg/dL |
Urinalysis | RBC 15–20/HPF |
Urine culture | No growth |
Ultrasound KUB
Ultrasound of the kidneys, ureters and bladder showed a 7-mm calculus in the right proximal ureter with mild right hydronephrosis. The left kidney appeared normal.
NCCT KUB
Non-contrast CT of the kidneys, ureters and bladder confirmed a 7 × 5 mm right proximal ureteric calculus with mild upstream hydroureteronephrosis. No additional significant calculi were identified.
Diagnosis
The clinical presentation and imaging findings were consistent with a 7-mm right proximal ureteric calculus causing renal colic with mild hydroureteronephrosis.
Management
Initial Treatment
Initial management focused on controlling pain and associated symptoms while monitoring for complications.
- Adequate analgesia, preferably an NSAID where appropriate and not contraindicated.
- An antiemetic for nausea and vomiting.
- Adequate but not excessive oral fluid intake.
- Urine straining to allow stone analysis if the calculus passed.
Medical Expulsive Therapy
An alpha-blocker such as tamsulosin may be considered for selected ureteric stones, particularly distal stones. Its benefit is less established for proximal ureteric calculi.
Because this calculus measured 7 mm and was located in the proximal ureter, spontaneous passage was considered less likely than with a smaller distal stone. Urological consultation was therefore appropriate if the stone did not pass or symptoms persisted.
Procedural Options
If intervention became necessary, potential options included:
- Ureteroscopy with laser lithotripsy
- Shock-wave lithotripsy
- Temporary ureteric stenting when clinically indicated
The choice of treatment depends on factors including stone size and location, degree of obstruction, symptoms, renal function and the patient’s clinical circumstances.
Red Flags Requiring Urgent Attention
Fever, chills, hypotension, worsening renal function, anuria or an infected obstructed urinary system require urgent urological management.
An infected obstructed kidney is a urological emergency and generally requires urgent drainage rather than waiting for spontaneous stone passage.
Stone Prevention
Following the acute episode, preventive measures can help reduce the risk of recurrent stone formation.
- Maintain adequate fluid intake to produce approximately 2–2.5 litres of urine per day.
- Reduce excessive salt intake.
- Maintain normal dietary calcium rather than unnecessarily restricting calcium.
- Avoid excessive animal protein intake.
- Consider metabolic evaluation, especially in patients with recurrent stones.
- Analyse the stone composition whenever possible.
Follow-Up
Repeat imaging can be arranged to confirm stone passage and resolution of the hydroureteronephrosis.
If the stone persists, symptoms continue or obstruction worsens, urological intervention may be required. Renal function and clinical symptoms should also be monitored during follow-up.
Conclusion
This case highlights the presentation of a 7-mm proximal ureteric calculus causing renal colic and mild hydroureteronephrosis. Appropriate imaging, symptom control and careful follow-up are important in determining whether spontaneous passage is possible or whether a urological procedure is required.
Timely evaluation can also help identify complications such as significant obstruction or infection and ensure appropriate treatment.
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Medical Note: This case study is intended for educational purposes only. Diagnosis and treatment should be based on an individual clinical assessment by a qualified healthcare professional.
