Table 1.
Diagnostic steps in urolithiasis (UTI urinary tract infection, CT computed tomography, MRI magnetic resonance imaging, PTH parathyroid hormone, pCO2 partial pressure of carbon dioxide)
| Step | Diagnostic findings |
|---|---|
| History, including family history | Diet, fluid intake, medication, vitamin supplementation |
| Chronic diseases? Malabsorption syndromes? | |
| Immobilization? | |
| Clinical findings | Pain, hematuria, vomiting, UTI |
| Passage of stones, gravel | |
| Imaging | Ultrasonography, (plain film) |
| Non-contrast-enhanced CT, (MRI) | |
| (Intravenous urography) | |
| Urine | Density, specific gravity (osmolality), pH, glucose, protein, sediment, culture |
| Spot urine: molar creatinine ratios of calcium, oxalate, uric acid, citrate, magnesium | |
| Cystine screening (nitroprusside test, amino acid screen) | |
| 24 hour urine: volume, pH; (lithogenic and stone-inhibitory parameters); calculation of urinary saturation | |
| Blood/serum | Electrolytes, calcium, phosphorus, magnesium, creatinine, urea, uric acid, alkaline phosphatase, (PTH, vitamins D/A, plasma oxalate, serum vitamin B6 level) |
| Acid-base status (pH, pCO2, base excess and/or standard bicarbonate) | |
| Stone analysis | Infrared spectroscopy or X-ray diffraction |