A 40 yo female presents with right flank pain.  The pain is sharp, intermittent and associated with dysuria.  She has no fever, hematuria or n/v. Vitals are normal, she appears uncomfortable on exam and she has right flank tenderness.  UA reveals +Nitrate, <180WBC, 40RBC  What's the diagnosis? (scroll down for answer)

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Diagnosis:  Mild-moderate right hydronephrosis

• Urinary tract obstruction, in this case secondary to a distal ureteral stone, can lead to infection, sepsis, and permanent renal injury
• Patients with infection in conjunction with obstructing renal stone require urologic consultation and admission for IV antibiotics covering gram negative organisms
• Urologic interventions for nephrolithiasis include shock wave lithotripsy, ureteral stenting and less commonly laparoscopic stone removal