Version July 2025
| Pain characteristics | Associated features | U/A | Cultures | Imaging | Treatment | |
| Cyst hemorrhage | Sudden onset | Usually afebrile | +/- Hematuria | Negative | CT or MRI | Analgesics |
| Localized, unilateral | Nausea/vomiting | Cultures negative | Bed rest and hydration | |||
| Sharp | Hematuria possible | Compression on affected side | ||||
| Improves after a few days | If shock: transfusions | |||||
| Pyelonephritis | Uni/bilateral | High-grade fever | WBCs/pyuria | Urine positive | Not indicated with positive cultures | IV antibiotics with good urine concentration (four weeks), followed by PO treatment |
| Progressive | Nausea/vomiting | +/- Bacteria | +/- Positive Blood | CT or MRI | ||
| Diffuse ++ | Dysuria | +/- Hematuria | ||||
| Sepsis | ||||||
| Cyst infection | Unilateral, localized | Fever | Usually bland | Urine negative | CT or MRI | Cyst penetrating antibiotics (four weeks minimum) |
| Subacute | Nausea/vomiting | Blood positive in 50% | WBC tagging if uncertain | Longer recovery time | ||
| Sharp ++ | ||||||
| Nephrolithiasis | Unilateral | Usually afebrile unless infection | Hematuria common | Usually negative unless infected stone | Spiral CT | IV hydration |
| Acute, sharp +++ | Nausea/vomiting | Crystals (uric acid and/or calcium oxalate) | Stone protocol | Analgesics | ||
| Paroxysmal | Ureteroscopy | |||||
| Renal colic | Percutaneous nephrolithotomy | |||||
| Radiation to pelvis or groin | Open surgery | |||||
| Chronic cyst/renal pain | Diffuse | Afebrile | Chronic hematuria possible | Negative | Usually negative | Analgesics |
| Constant | No WBC | Cyst aspiration +/- sclerosis with ethanol or tetracyclines if few large cysts causing pain | ||||
| Variable intensity | Cyst reduction surgery | |||||
| Positional in nature aggravated by inspiration, automobile, sudden impact movements | Nephrectomy |
