An adolescent has right-sided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the PCP suspects nephrolithiasis. What is the initial treatment?

An adolescent has right-sided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the PCP suspects nephrolithiasis. What is the initial treatment?

• A. Extracorporeal shockwave lithotripsy (ESWL)
• B. Increasing fluid intake up to 2 L daily
• C. Percutaneous removal of renal calculi
• D. Referral to a pediatric nephrologist

Answer: (B)

The key idea is to manage suspected nephrolithiasis in a conservative way first, promoting spontaneous passage of the stone while avoiding dehydration. Encouraging the adolescent to drink more fluid, aiming for about 2 liters per day, increases urine volume and helps flush small stones through the urinary tract. This simple step is appropriate when there are no signs of infection or obstruction, and it can reduce the chance that the stone remains and causes ongoing pain or complications. Invasive treatments like extracorporeal shockwave lithotripsy or percutaneous removal are reserved for stones that won’t pass, are too large, or cause obstruction. Referral to a pediatric nephrologist is more for metabolic workup or recurrent stones rather than the initial management of a single episode.

The key idea is to manage suspected nephrolithiasis in a conservative way first, promoting spontaneous passage of the stone while avoiding dehydration. Encouraging the adolescent to drink more fluid, aiming for about 2 liters per day, increases urine volume and helps flush small stones through the urinary tract. This simple step is appropriate when there are no signs of infection or obstruction, and it can reduce the chance that the stone remains and causes ongoing pain or complications. Invasive treatments like extracorporeal shockwave lithotripsy or percutaneous removal are reserved for stones that won’t pass, are too large, or cause obstruction. Referral to a pediatric nephrologist is more for metabolic workup or recurrent stones rather than the initial management of a single episode.