Kidney stones need to be differentiated from the following diseases. Gallstones can cause biliary colic, which can be easily confused with right-sided renal colic. When gallstones are combined with cholecystitis, there may be persistent pain in the right upper abdomen with paroxysmal intensification and positive Murphy’s sign. Sometimes there may be an enlarged gallbladder under the right costal margin that is painful to touch and moves with breathing, or a mass wrapped in large omentum with unclear borders and little mobility that is painful to touch. Routine urine examination is usually normal in patients with gallstones, and ultrasound examination can confirm the diagnosis. 2, renal tuberculosis Kidney stones combined with obstruction and infection should be differentiated from renal tuberculosis. The kidney tuberculosis often has chronic and persistent bladder irritation, with no significant effect by general antibiotic treatment; there are pus cells in the urine, but no bacterial growth in ordinary urine culture; sometimes accompanied by pulmonary tuberculosis or small tuberculosis lesions in the kidney; cystoscopy can see congestion and edema, tuberculous nodules, tuberculous ulcers, tuberculous granuloma and scar formation and other lesions, especially in the bladder triangle and near the ureteral opening. The ureteral orifice is often cavernous and sometimes cloudy urine discharge is seen; calcified renal tuberculosis is seen on plain radiographs with extensive calcification throughout the kidney, and in focal cases, speckled calcified shadows are seen in the kidney. The early X-ray of renal tuberculosis imaging shows that the edge of the renal calyx is untidy, with worm-like changes, and in severe cases, the renal calyx is occluded, cavity formation, irregular enlargement of the renal calyx and renal pelvis or blurred deformation. The incidence of spongy kidney is 1/5000, the patient’s renal medullary collecting ducts are cystic dilated, the general appearance of sponge-like. 70% of cases have bilateral renal lesions, each kidney has one to several papillae involved. The disease is present at birth but is asymptomatic and is usually not detected until the age of 40 to 50 years due to the development of stones or infectious comorbidities. Prolonged urinary retention due to dilated collecting ducts, combined with frequent combined hypercalcemia, is responsible for the development of stones and infections. Renal tubular concentration and acidification are often impaired. Abdominal plain radiographs show normal or mildly enlarged kidneys of normal size and clusters of multiple stones (arranged radially in the papillary region) within the kidney area. Intravenous pyelogram shows a fan-like cystic expansion of the medullary collecting ducts as a basis for the diagnosis of this disease. 4. Renal pelvic tumors Most renal pelvic tumors are papillary tumors, and there is often no obvious boundary between benign and malignant, and the metastatic pathway is the same as that of renal cancer; because of the thin wall of the renal pelvis and abundant surrounding lymphatic tissue, there are often early lymphatic metastases. The disease mostly occurs after the age of 40, and there are more men than women. In the early stage, the disease is characterized by painless hematuria without obvious masses; in the late stage, masses may appear when the tumor increases and causes obstruction. Tumor cells are sometimes seen on urine sediment examination, and blood spraying from the ureteral orifice on the affected side can be seen on cystoscopy during hematuria. CT and ultrasound can help to differentiate. 5.Biliary Ascariasis When kidney stone patients present with renal colic, it should be differentiated from biliary ascariasis. The main manifestation of biliary ascariasis is the paroxysmal “drill-like” severe colic under the raphe, which is characterized by sudden attack and rapid relief. During the attack, the patient often tosses and turns, sweats all over the body, and even turns pale and has cold limbs, and is often accompanied by nausea and vomiting, and the vomit may contain bile or even roundworms. In between attacks, the pain can disappear completely. Ultrasound can make a clear diagnosis. 6.Acute appendicitis When renal colic occurs in patients with right kidney stone, attention should be paid to differentiate it from acute appendicitis. Metastatic right lower abdominal pain is a feature of acute appendicitis. 70% to 80% of patients feel pain in the upper abdomen at the beginning of the attack, and then it shifts to the right lower abdomen a few hours to a dozen hours later. The upper abdominal pain is generally thought to be caused by visceral nerve reflexes, while the right lower abdominal pain is due to inflammation irritating the right lower abdomen. The abdominal signs of acute appendicitis are manifested by limited fixed and obvious pressure points in the right lower abdomen, when the pressure pain is fixed in the right lower abdomen before the abdominal pain has shifted to the right lower abdomen, which is of diagnostic importance. If the symptoms are atypical or the location of the appendix is abnormal, other symptoms and signs should be referred for differentiation. If it is difficult to confirm the diagnosis for a while, close observation and comprehensive analysis should be made to reduce misdiagnosis. 7, acute pancreatitis Abdominal pain is the main symptom of acute pancreatitis. Abdominal pain often begins in the upper abdomen, but can be limited to the right or left upper abdomen, depending on the site of lesion invasion. If the lesion of the head of the pancreas is combined with biliary tract disorders, in addition to right upper abdominal pain, it may radiate to the right shoulder or right lumbar region; when the inflammation mainly invades the tail of the pancreas, the epigastric pain may radiate to the back of the left shoulder. The nature and intensity of pain is mostly consistent with the extent of the lesion. Edematous pancreatitis is mostly persistent pain, which can be accompanied by paroxysmal aggravation and is mostly tolerable; hemorrhagic or necrotizing pancreatitis is mostly severe pain like cutting, which is not easily relieved by general analgesics, and shock can occur in severe cases. According to the history, signs and blood and urine amylase measurement, the diagnosis of most acute pancreatitis can generally be established. 8. Ovarian cyst torsion When renal colic occurs in female patients with kidney stones, attention should be paid to differentiate it from ovarian cyst torsion. The typical symptoms of ovarian cyst torsion are sudden onset of severe abdominal pain and even shock, nausea and vomiting. Gynecologic examination reveals a mass with significant pressure pain and tension with limited muscle tension. If the torsion occurs slowly, the pain is mild, and sometimes the torsion can reset itself and the pain is relieved. Lymph node calcification can be misdiagnosed as a kidney stone if it is located within the kidney area. Lymph node calcification is a round granular dense shadow, internally heterogeneous, multiple and scattered, intravenous urography film plus lateral film can help to distinguish it from kidney stone. 10.Other kidney stones should also be differentiated from other related diseases that cause low back pain and abdominal pain, such as ruptured ectopic pregnancy, gastritis, gastric ulcer and other diseases.