Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Kidney Stone (Ureterolithiasis)

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In one line

·A tiny rock slides down the drain from kidney to bladder and gets wedged in the pipe, so the kidney backs up and the body screams.

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Normal physiology

·The kidneys sit in your back on each side, below your ribs. They filter your blood and make pee. Pee drains through a narrow pipe called the ureter — about the width of a pencil lead — from each kidney down into the bladder. The ureter has three natural narrow spots where a stone is most likely to get stuck.

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What goes wrong

·Minerals in the pee — mostly calcium oxalate, sometimes uric acid or struvite — clump together and harden into a stone. If that stone moves out of the kidney and gets stuck in the ureter, pee cannot flow past it. The pressure backs up into the kidney above.

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Hallmark signs

·Sudden, severe pain in the side (flank) that shoots down to the groin
·Restlessness—constantly shifting position, can't sit still or get comfortable
·Blood in the urine (pink, red, or brown pee, or only visible under a microscope)
·Nausea and vomiting
·Needing to pee often and urgently, especially when the stone is almost in the bladder
·Fever and shaking chills
·No urine coming out, and rising creatinine (a blood test showing kidney function is dropping)

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Red flags · escalate now

·Fever in a patient who has a swollen, backed-up kidney (hydronephrosis) on imaging
·No urine output (anuria) and creatinine rising in the blood
·Stone larger than 10 millimeters (about the width of a small pea)
·Severe pain that does not get better even with strong IV pain medicines (like ketorolac or morphine)

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Workup

·Non-contrast CT scan of the abdomen and pelvis
·Bedside renal ultrasound
·Urinalysis (urine dipstick and microscopy)
·Basic metabolic panel (BMP)
·Complete blood count (CBC)
·Stone strain (patient collects any passed stone in a filter)

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Treatment

·Intravenous (IV) fluids plus IV ketorolac (an NSAID pain medicine), with opioid rescue if needed
·IV ondansetron (an anti-nausea medicine)
·Tamsulosin (an alpha-blocker) for medical expulsive therapy
·Ureteral stent or percutaneous nephrostomy tube (a drainage tube through the skin into the kidney)
·Extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy with laser lithotripsy

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NCLEX trap

·Kidney stone pain (renal colic) is severe and safe to treat right away. Giving pain relief early does not hide the diagnosis — imaging and urinalysis still work fine. Waiting only makes the patient suffer needlessly. NSAIDs like ketorolac or IV acetaminophen are first-line; opioids can be added if needed.
·Give fluids to restore normal volume (euvolemia) if the patient is dehydrated from vomiting or not drinking. But flooding the system with aggressive fluids does NOT push stones down the ureter and can actually stretch the kidney capsule more, making the pain worse. Let the stone pass on its own with normal hydration.
·Fever plus a blocked kidney (hydronephrosis on CT) means infected urine is trapped behind the stone — this is called obstructive pyelonephritis, and it can turn into life-threatening sepsis in hours. The blockage must be relieved urgently (within 6–12 hours) with a ureteral stent or a nephrostomy tube. Antibiotics alone cannot reach the infected urine pool behind the stone. This is a true emergency.
·Strain ALL urine from the moment a stone is diagnosed until the stone passes or is removed. Catching the stone lets the lab analyze what it is made of (calcium oxalate, uric acid, struvite, cystine) — that analysis guides prevention (diet changes, medications) so future stones are less likely. If you miss the stone, you lose the chance to personalize prevention.
·Stones under 5 mm have a high chance of passing (about 70–90 % within 4 weeks), but some do not pass and can cause silent obstruction or infection. Every stone patient needs a follow-up plan: repeat imaging if symptoms do not resolve in 4–6 weeks, urine strain to catch the stone, and a metabolic work-up if this is a recurrent stone or a high-risk patient (young age, family history, single kidney). Never assume 'small means safe to forget.'

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