Nephrolithiasis
Pathology: Nephrolithiasis (kidney stones) occurs most commonly as a result of dehydration or excessive calcium intake (NCBI Website).
Red Flags:
Demographics: Nephrolithiasis is a multifactorial disorder and is often related to dietary habits. Annually, approximately 1 in 1,000 adults in the United States are hospitalized for treatment of nephrolithiasis resulting in medical costs of approximately 2 billion dollars annually (Colella, 2005).
Clinical Presentation: The patient may present with lower quadrant pain on the involved side accompanied by ipsilateral shoulder pain. The shoulder pain is due to the anatomic position of the kidney relative to the diaphragm (NCBI Website; Dutton, 2008).
Differential Diagnosis: Murphy’s percussion test – assesses for costovertebral tenderness to rule out involvement of the kidney. Patient positioned in prone. Therapist places one palm on the patient’s costovertebral angle while the therapist uses the other fisted hand to apply a percussive thump with the ulnar side. The patient will feel a thump along with reproduction or exacerbation of pain with a positive test which is indicative of kidney involvement (Goodman & Snyder, 2007).
Please refer to video below for demonstration of the Murphy's Percussion Test.
Clinical Bottom Line: Refer out
Refer to physician for further testing for renal involvement.
Red Flags:
- Sudden, severe back or flank pain
- Chills and fever
- Nausea or vomiting
- Renal colic
- Symptoms of urinary tract infection
- Reside in hot and humid environment
- Past episode(s) are kidney stone(s) (Dutton, 2008)
Demographics: Nephrolithiasis is a multifactorial disorder and is often related to dietary habits. Annually, approximately 1 in 1,000 adults in the United States are hospitalized for treatment of nephrolithiasis resulting in medical costs of approximately 2 billion dollars annually (Colella, 2005).
Clinical Presentation: The patient may present with lower quadrant pain on the involved side accompanied by ipsilateral shoulder pain. The shoulder pain is due to the anatomic position of the kidney relative to the diaphragm (NCBI Website; Dutton, 2008).
Differential Diagnosis: Murphy’s percussion test – assesses for costovertebral tenderness to rule out involvement of the kidney. Patient positioned in prone. Therapist places one palm on the patient’s costovertebral angle while the therapist uses the other fisted hand to apply a percussive thump with the ulnar side. The patient will feel a thump along with reproduction or exacerbation of pain with a positive test which is indicative of kidney involvement (Goodman & Snyder, 2007).
Please refer to video below for demonstration of the Murphy's Percussion Test.
Clinical Bottom Line: Refer out
Refer to physician for further testing for renal involvement.
