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Does Circadian rhythm influence timing of renal colic

Three Part Question

[in adults] [does Circadian rhythm] [influence timing of renal colic]

Clinical Scenario

After working on the A&E department for 4 months, you are presented with your umpteenth patient with renal colic. You notice that this is the third patient in a row who has presented in the morning and consider if there is a link between the Circadian rhythm and renal stones.

Search Strategy

Ovid MEDLINE 1946 to June week 3 2012
Embase 1974 to 2012 July
Cochrane Database of Systematic Reviews 2005 to June 2012

[exp Circadian Rhythm/] OR [exp Circadian Clocks/] OR [] AND [exp Kidney Calculi/] OR [exp Ureteral Calculi/] OR [exp Urolithiasis/] OR [exp Nephrolithiasis/]

Search Outcome

108 papers found Medline
116 papers found EMBase
6 relevant papers found, excluding duplicates and poor quality studies; 3 papers used.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Manfredini R, Gallerani M, Cecilia O et al
All patients with renal colic between 1/1/90 and 31/12/96Retrospective case series: 3410 colic episodes, of which time of pain starting could be determined in 3360.If renal colic occurs in a Circadian pattern.Highly significant Circadian rhythm found (p < 0.001), with morning peak and low in the afternoon.Retrospective.
Robert M, Roux J, Bourelly F et al
Patients with recurring calcium oxalate stones or control patients with no history/xray evidence of stonesCase control study: 50 patients. 25 (50%) with recurrent stones, 25 (50%) no history stones.Concentrations of urinary lithogenic substances eg Oxalate, calcium, citrate, magnesium and calcium oxalate molar product.Urine crystallisation potential, and therefore lithogenic risk, is maximum at end of night or during day in both groups.Small sample size. Supported by weak theories concerning causes of stones.
Vahlensieck E, Bach D, Hesse A
Patients with calcium oxalate stones vs healthy patientsCase control study: 20 patients (53%) with stones, 18 (47%) Concentrations of lithogenic substances throughout day.Evidence of Circadian rhythm in lithogenic substances; maximum in early hours and lowestSmall sample size. Supported by weak theories concerning causes of stones.


One large retrospective case series indicates a strong link between renal colic/renal stones and Circadian rhythm, with two poor quality studies giving weak supportive evidence that substances linked to the creation of renal stones follow Circadian rhythms. Further large scale retrospective analyses would shed more light on the subject.

Clinical Bottom Line

Renal calculi, and therefore colic, are slightly more likely to present in the morning than at any other time of day.


  1. Manfredini R, Gallerani M, Cecilia O et al. Circadian pattern in occurrence of renal colic in an emergency department: analysis of patients' notes. BMJ 2002; 324(7340):767
  2. Robert M, Roux J, Bourelly F et al. Circadian variations in the risk of urinary calcium oxalate stone formation. Br J Urol 1994; 74(3):294-7
  3. Vahlensieck E, Bach D, Hesse A. Circadian rhythm of lithogenic substances in the urine. Urol Res 1982; 10(4):195-203