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Renal colic from nephrolithiasis presents with sudden, severe, colicky flank or groin pain that often radiates as the stone moves through the ureter. The intense irritation of the urinary tract commonly causes visible blood in the urine, along with nausea or vomiting and restlessness as the patient struggles with the pain. These features—sudden onset, severe location of pain, hematuria, and associated nausea/vomiting with agitation—are the hallmark signs clinicians look for.

Chronic back pain without hematuria or a gradual dull flank pain with stable vitals fit more with musculoskeletal or other non-urgent causes, and an asymptomatic incidental finding wouldn’t reflect the acute, painful presentation described here. The key clue is the sudden, severe pain paired with blood in the urine and GI upset, signaling a stone traveling through the urinary tract.