If a patient has a kidney stone and fever, what is the immediate next step in management?

• A. CT scan of the abdomen
• B. Outpatient management with oral fluids
• C. Percutaneous nephrostomy tube placement
• D. Ureteroscopy

Answer: (C)

In the case of a patient presenting with a kidney stone and fever, the priority is to address the acute potential for infection, particularly considering the risk of obstructive uropathy. Fever indicates the possibility of an upper urinary tract infection or pyelonephritis, especially if there is an obstructing stone present.

The immediate next step in management should focus on relieving any obstruction caused by the stone and managing the infection to avoid serious complications such as sepsis. A percutaneous nephrostomy tube placement provides immediate drainage of the obstructed kidney, which can help alleviate the buildup of urine and help with the associated infection. This intervention can be crucial if the patient is experiencing significant symptoms or if there is evidence of systemic infection.

Other options, such as performing a CT scan or awaiting outpatient management with fluids, would delay necessary intervention in the context of a fever and possible obstruction, which could lead to further complications. Ureteroscopy can be performed once the patient is stable, but immediate intervention through nephrostomy is essential to manage the acute situation effectively.