• 
• 

Three Part Question

[in adults with suspected renal colic] [are clinical factors sensitive] for [the diagnosis of renal stones]

Clinical Scenario

A 43 year old gentleman presents to A&E with left loin pain, which radiates to his left testicle. The doctor on call immediately suspects renal stones due to this “classic” presentation, however you wonder how sensitive this symptom really is.

Search Strategy

Ovid MEDLINE 1946 to June week 3 2012
Embase 1974 to 2012 July
Cochrane Database of Systematic Reviews 2005 to June 2012
Pubmed
[clinical characteristics.mp.] OR [clinical features.mp.] OR [symptom incidence.mp.] AND [exp Kidney Calculi/] OR [exp Urolithiasis/] OR [ureteral calculi.mp.] OR [exp Ureteral Calculi/] OR [exp Renal Colic/] OR [renal colic.mp.] limit to english and humans and adult over 18 years old

Search Outcome

78 papers found on Medline
236 papers found on EMBase
3 papers found on pubmed
3 relevant papers found through references on Pubmed, one of high enough quality to report.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Kartal M, Eray O, Erdogru T et al. 2006 Turkey	Consecutive patients presenting to ED with unilateral loin pain	Prospective validation study: 227 patients enrolled, 176 diagnosed with renal stones on IVU, CT or passage of stones.	Significance or sensitivity and specificity for renal colic of: history of stones; radiation of pain to groin; nausea; costovertebral tenderness	History of stones (sensitivity 59%, specificity 67%), radiation to groin (sensitivity 68%, specificity 49%) and nausea are significant independent markers; costovertebral tenderness and vomiting not significant.	Stones may have been missed by patients during urination or on IVU

Comment(s)

There are very few articles in the literature concerning this important aspect of renal stones. The concept that renal stones cause severe pain which radiates to the groin is commonly held however poorly evaluated. A single study with low level evidence suggests that a history of stones, radiation of pain to groin and nausea have reasonable sensitivity for clinical diagnosis of renal colic. Analysis into the sensitivity of combinations of symptoms, and means of fashioning these into scoring systems of likelihood of renal stones would be ideal. Further large scale trials focussed on the clinical characteristics of renal calculi are required.

Clinical Bottom Line

Combinations of clinical characteristics could be used to clinically diagnose patients; however investigations such as dipstick and US are recommended.

References

1. Kartal M, Eray O, Erdogru T et al. Prospective validation of a current algorithm including bedside US performed by emergency physicians for patients with acute flank pain suspected for renal colic. Emerg Med J 2006; 23:341-4