Management of Nephrolithiasis in the Urgent Care Setting

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Delivery Method:	Online
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Publication Date: January 2025 (Volume 4, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 01/01/2028.

Update Contributors

Peer Reviewer

Abstract

The incidence of nephrolithiasis has been increasing in recent years, making it a common presenting condition in the urgent care. The clinical presentation of nephrolithiasis is variable and overlaps with other serious medical conditions, so urgent care clinicians must be able to identify the condition and be familiar with evidence-based recommendations for evaluation and treatment. This article reviews the pathogenesis, symptomatology, initial diagnostic workup, and current medical management of this condition in the urgent care setting. It also reviews clinical scenarios in which patients with nephrolithiasis should be emergently referred for specialty care.

Case Presentations

A 27-year-old man presents to the urgent care with complaints of right upper quadrant abdominal pain for 1 week...

• He reports some nausea but has not had any other gastrointestinal complaints.
• He has not noticed any urinary difficulties but reports his urine has been slightly darker than usual. He attributes this to not eating well due to nausea and feeling “dehydrated.”
• You wonder if a urine culture may be needed in addition to urinalysis...

An obese 35-year-old man walks into the urgent care with complaints of vomiting and pain over his left flank...

• Over the past 24 hours he has developed worsening pain over his left flank, and he started vomiting this morning.
• Other than having difficulty losing weight, he reports no other known medical problems.
• He has a family history of nephrolithiasis in his mother, and gout in an uncle.
• He is urinating more frequently and is sweaty on examination.
• You wonder if this could be a kidney stone or a kidney infection...

A 40-year-old woman presents at the urgent care clinic with 2 days of left-sided lower back pain that radiates down her left groin…

• Over the past 2 days, her pain has been moderate but is now starting to interrupt her sleep.
• She has a history of dysmenorrhea and polycystic ovary syndrome.
• She initially thought her pain was due to upcoming menses, but when she awakened this morning, she experienced dysuria.
• The patient asks you if you think she has a urinary tract infection...

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