Main Article Content

Kenneth Krayenhagen
Judy Bhatti
Elissa Twist


Nephrolithiasis, Mechanical Back Pain, Referred Pain


Objective : This case report serves to describe an unusual presentation of nephrolithiasis. Often this condition can mimic mechanical back pain. The clinician may treat it as such and be fooled by short-term remission of symptoms.

Clinical Features: A 63 -year-old female who had been successfully treated for the prior 3 weeks for low back pain (LBP) and sacral-iliac joint pain (SJP) with chiropractic treatment subsequently came withl mid-thoracic pain. The presentation suggested mechanical back pain. During the examination, her pain was increasing and becoming more colicky in nature. She was sent for a series of x-rays. A KUB (Kidney, Ureter, Bladder) radiograph revealed a 2.6 cm (about 1.02 in) calcification within the left renal system.

Intervention and Outcomes: She was referred to a urologist for CT scan and required surgery. Post-surgery, her pain subsided.

Conclusion: This case demonstrates that nephrolithiasis can imitate mechanical lesions with the LBP and SJP. Since visceral and mechanical back pain share some common symptoms, it is easy to miss the diagnosis. Clinicians should always consider referred pain of visceral origin until it is ruled out. Chiropractors should consider abdominal radiographs if visceral origin of back pain is suspected.


Download data is not yet available.
Abstract 128 | ATYPICAL NEPHROLITHIASIS Downloads 75


1. Khan A. Prevalence, pathophysiological mechanisms and factors affecting urolithiasis. Int Urol Nephrol 2018;50(5):799-806. doi:10.1007/s11255-018-1849-2
2. Chen Z, Prosperi M, Bird VY. Prevalence of kidney stones in the USA: the national health and nutrition evaluation survey. J Clin Urology 2019;12(4):296-302. doi:10.1177/2051415818813820
3. Chen HW, Chen YC, Yang FM et al. Mediators of the effects of gender on uric acid nephrolithiasis: a novel application of structural equation modeling. Sci Rep 2018;8(1):6077. doi:10.1038/s41598-018-24485-x
4. Gillams K, Juliebø-Jones P, Juliebø SØ, Somani BK. Gender differences in kidney stone disease (KSD): findings from a systematic review. Curr Urol Rep 2021;22(10):50. doi:10.1007/s11934-021-01066-6
5. Oliva Pascual-Vaca Á, Punzano-Rodríguez R, Escribá-Astaburuaga P et al. Short-term changes in algometry, inclinometry, stabilometry, and urinary ph analysis after a thoracolumbar junction manipulation in patients with kidney stones. J Alternative Compl Med 2017;23(8):639-647. doi:10.1089/acm.2017.0041
6. Wang K, Ge J, Han W, et al. Risk factors for kidney stone disease recurrence: a comprehensive meta-analysis. BMC Urol 2022;22(1):62. doi:10.1186/s12894-022-01017-4
7. Wu T, Liu Z, Ma S, Xue W, Jiang X, Ma J. Should we support prophylactic intervention for asymptomatic kidney stones? A retrospective cohort study with long-term follow-up. Urolithiasis 2022;50(4):431-437. doi:10.1007/s00240-022-01331-4

8. Hyams ES, Matlaga BR. Economic impact of urinary stones. Transl Androl Urol 2014 Sep;3(3):278-83. Doi: 10.3978/j.issn.2223-4683.2014.07.02. PMID: 26816777; PMCID: PMC4708578.
9. Alelign T, Petros B. Kidney stone disease: an update on current concepts. Adv Urology 2018;2018:1-12. doi:10.1155/2018/3068365
10. Wells KA. Nephrolithiasis with unusual initial symptoms. J Manipulative Physiol Ther 2000;23(3):196-201. doi:10.1016/s0161-4754(00)90249-5.
11. Blanchette MA, Stochkendahl MJ, Borges Da Silva R, Boruff J, Harrison P, Bussières A. Effectiveness, and economic evaluation of chiropractic care for the treatment of low back pain: a systematic review of pragmatic studies. PLoS ONE 2016;11(8): e0160037. doi:10.1371/journal.pone.0160037
12. Chung, C, Stern, PJ, Dufton, J. Urolithiasis presenting as right flank pain: a case report. J Canadian Chiropr Assoc 2013; 57(1), 69-75.
13. Vining RD, Minkalis AL, Shannon ZK, Twist EJ. Development of an evidence-based practical diagnostic checklist and corresponding clinical exam for low back pain. J Manipulative Physiol Ther 2019;42(9):665-676. doi:10.1016/j.jmpt.2019.08.003
14. Wolcott CC. An atypical case of nephrolithiasis with transient remission of symptoms following spinal manipulation. J Chiropr Med 2010;9(2):69-72. doi:10.1016/j.jcm.2010.02.005
15. Yelland MJ. Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain? Aust Fam Physician 2001;30(9):908-12. PMID: 11676323.
16. Takazawa R. Appropriate kidney stone size for ureteroscopic lithotripsy: When to switch to a percutaneous approach. West J Nurs 2015;4(1):111. doi:10.5527/wjn.v4.i1.111
17. Crivelli JJ, Maalouf NM, Paiste HJ et al. Disparities in kidney stone disease: a scoping review. J Urology 2021;206(3):517-525. doi:10.1097/JU.0000000000001846
18. Mirmozaffari M. Presenting a medical expert system for diagnosis and treatment of nephrolithiasis. European J Med Health Sci 2019;1 doi:10.24018/ejmed.2019.1.1.20
19. Lamb ADG, Wines MD, Mousa S, Tolley DA. Plain radiography still is required in the planning of treatment for urolithiasis. J Endourology 2008;22(10):2201-2206. doi:10.1089/end.2008.9716

20. Varma G, Nair N, Salim A, Fazil Marickar, YM. . Investigations for recognizing urinary stone. Urological Res 2009;36:157-232. doi:10.1007/s00240-008-0145-5

21. Kluner C, Hein PA, Gralla O, Hein E, Hamm B, Romano VC, Rogalla P. Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi?” J Computer Assisted Tomography 2006;30:44-50
22. Grases F, Costa‐Bauzá A, Ramis M, Montesinos V, Conte A. Recurrence of renal lithiasis. Scand J Urology Nephrol 2003;37(6):482-486. doi:10.1080/00365590310014490
23. Roberson D, Sperling C, Shah A, Ziemba J. Economic considerations in the management of nephrolithiasis. Curr Urol Rep 2020;21(5):18. doi:10.1007/s11934-020-00971-6
24. Wong Y, Cook P, Roderick P, Somani BK. Metabolic syndrome, and kidney stone disease: a systematic review of literature. J Endourology 2016;30(3):246-253. doi:10.1089/end.2015.0567
25. Afsar B, Kiremit MC, Sag AA et al. The role of sodium intake in nephrolithiasis: epidemiology, pathogenesis, and future directions. European J Internal Med 2016;35:16-19. doi:10.1016/j.ejim.2016.07.001
26. Stern JM, Moazami S, Qiu Y et al. Evidence for a distinct gut microbiome in kidney stone formers compared to non-stone formers. Urolithiasis 2016;44(5):399-407. doi:10.1007/s00240-016-0882-9
27. Umare V, Sheikh SN, Umate R, Mahatme C. Urolithiasis presenting as right flank pain. JPRI. Published online December 22, 2021:777-781. doi:10.9734/jpri/2021/v33i60B34679
28. Bakkum BW, Cramer GD. Spinal manipulative therapies in visceral conditions. J Alternative Compl Med 2018;24(2):104-105. doi:10.1089/acm.2017.0327