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Chiropractic Research Review

Clinical Diagnosis of Nephrolithiasis

Accurate diagnosis of nephrolithiasis, the development of stones formed in the kidney, is vital to avoiding treatment delays, identifying underlying metabolic cause and extent of disease, and reducing incidence of recurrence.

Chiropractors must be aware of this clinical manifestation, particularly because the passing stone often causes back pain at the costovertebral angle.

This paper reports on a case of nephrolisthiasis in a 25-year-old man presenting with bilateral stabbing inguinal pain and periumbilical pain which occurred a few hours prior to his usual chiropractic visit. Costovertebral angle pain followed one hour later, and a kidney, ureter and bladder radiograph revealed a 2x3 millimeter stone lodged at the left vesico ureteral junction. The patient was referred to a medical center to receive extracorporeal shock-wave lithotripsy several days after the initial visit.

The patient case serves as a starting point for a thorough discussion of kidney stones, including the following points:

* prevalence;
* cause;
* typical presentation and diagnosis;
* short and long-term management;
* dietary habits as risk factors.

Conclusion: The author emphasizes that "Although this condition is usually easy to recognize, diagnosis can be elusive if the typical historic factors and diagnostic factors are absent or altered." Short-term management of nephrolithiasis involves pain management, stone elimination, and the collection of a specimen to identify composition and underlying metabolic abnormality. Conservative chiropractic management can include nutritional assistance to reduce calcium oxalates, and lumbar spine adjustments to relieve pain.

Note: This case report is a good practical review of this potential differential diagnosis for low back pain. It stems from a patient case and discusses nonmedical and medical management of kidney stones.

Wells KA. Nephrolithiasis with unusual initial symptoms. Journal of Manipulative and Physiological Therapeutics, March/April 2000:23(3), pp196-201. Reprints: Tel: (800) 325-4177 (ext. 4350); Fax: (314) 432-1380

Chiropractic Research Review

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