- Some mimics of renal colic that may arrive at the ED include: upper UTI’s, ectopic pregnancies, ovarian torsion, adnexal masses, testicular torsion, acute aortic syndromes, renal artery aneurysms, renal infarction, splenic infarction, bowel obstruction, diverticulitis, appendicitis, biliary colic, cholecystitis, acute intestinal ischemia, pneumonia, pulmonary embolism, retroperitoneal hematoma, iliopsoas abscess.
- Focused history and physical exam are paramount due to the multitude of structures in the area and potentially dangerous conditions that may mimic renal colic.
- Flank pain and hematuria are the hallmarks of renal colic, however, the presentation is variable.
- Diagnosis can be confirmed with CT scan, which will show most other potential items in the differential if the scan is negative for a stone.
Lights criteria (High protein and LDH = exudate), determines presence of exudate with protein and LDH levels
- Pleural fluid protein to serum protein ratio >0.5
- Pleural fluid LDH to serum LDH ratio >0.6
- Pleural fluid level >2/3 of upper value for serum LDH
- Additional criteria – Confirm exudate if results equivocal
- Serum albumin – pleural fluid albumin <1.2g/dL