What are the presenting symptoms and signs of renal stones?
Approximately 30% of renal stones are asymptomatic and are found incidentally on radiographic studies. Seventy percent of renal stones are symptomatic. The patient may present with a dull ache in the posterior flank. However, the classic presenting symptom of renal stones is excruciating unilateral flank pain that waxes and wanes, and most patients have associated hematuria. The pain starts in the posterior lumbar area and then radiates anteroinferiorly into the abdomen, groin, genital region, and medial thigh. Intense pain may last several hours and may be followed by dull flank pain. Nausea, vomiting, sweating, fever, and chills may occur. Patients with renal colic appear acutely ill and restless and move from side to side in an attempt to relieve the pain. Physical examination shows tenderness and guarding of the respective lumbar area. Deep abdominal palpation worsens discomfort, but rebound tenderness is absent. Urinary tract infection may be present. Obstruction, if present, is usually unilateral. Clinical evidence of renal failure is typically absent.