Upper urinary tract

Kidney stones cause:

• flank pain:
  • spreads around the abdomen as the stone migrates
  • tends to be greater with smaller, more mobile stones than with larger, less mobile stones
• haematuria:
  • common
  • microscopic or macroscopic
• urinary infection:
  • acute loin tenderness, pyrexia and septicaemia
  • acute pyelonephritis in the presence of urinary obstruction is a urological emergency

Ureter:

• ureteric colic:
  • colicky pain from the flank through to the scrotum or labia majora
• haematuria
• urinary infection

Examination may reveal tenderness in the renal angle or along the line of ureter which is usually modest in comparison to the pain reported.

It should be noted that the presentation of stones in the renal tract is exceedingly variable. At one extreme, a stone may be an incidental finding on X-ray whereas at the other, bilateral stones may produce bilateral obstruction leading to bilateral hydronephrosis and renal failure.