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Renal Calculi

Checked: 23-05-2021 by Rob Adams Next Review: 23-05-2022

Overview

Refer to the CKS guidelines (1) on the assessment and management of renal colic with advice on initial management in primary care and when to seek specialist advice. Please note that CT KUB is now the investigation of choice and IVU, USS and plain films are usually not indicated.

(Think AAA - 10% of AAAs present as renal colic and may involve haematuria due to renal artery involvement. Admit as emergency or contact vascular on call team if in doubt).

Please note the guidance also recommends excluding infection and checking renal function, calcium, phosphate and urate levels.

Red Flags

Consider urgent hospital admission via the (nearest) emergency department if (1):

The person has signs of systemic infection (such as fever or sweats) or sepsis.
The person is at increased risk of acute kidney injury, for example, if they have pre-existing chronic kidney disease or a solitary or transplanted kidney, or bilateral obstructing stones are suspected.
The person is dehydrated and cannot take oral fluids due to nausea and/or vomiting.
The diagnosis is doubtful (think AAA even if haematuria is present)

For all other people with suspected acute renal or ureteric colic:

Offer urgent (within 24 hours of presentation) imaging to confirm the diagnosis and assess the likelihood of spontaneous stone passage (1) - see below for details on referral routes.

Referral

Acute Renal Colic

Refer patients with suspected acute renal colic to the Urology SDEC at NBT.

See the Urgent Care and Admissions (Urology) page for details.

Following diagnosis a follow up appointment should be automatically arranged with the Urology Stone Clinic at NBT. If a follow up appointment is not received then contact the Bristol Urology Institute stone team on 0117 4145007.

Asymptomatic/minimally symptomatic Renal Stones

Patients with minimally symptomatic or asymptomatic renal or ureteric stones who do not require immediate hospital admission should be referred for urgent direct access CT Renal (without contrast)/CT KUB (available on ICE). CKS suggests patients should be seen by a urologist within 7 days but this may not be achievable as there is currently no clinic locally that can be accessed in this timescale. If there are any concerns then discuss with urology on call team at NBT.

If CT Renal/CT KUB confirms renal calculi then patients should be referred to the Urology Stone clinic at NBT via e-RS (even if the patient is asymptomatic). Patient with renal calculi should not be referred to GP care urology. In patients without proven calculus on CT then alternative diagnosis should be considered and referrals to urology may be returned in these cases.

USS and plain X-ray for renal stones

USS scan and plain x-ray for diagnosis of renal stones is not recommended due to poor sensitivity of these tests, and should not be used as a first line investigation. USS may be considered where the risk of radiation is a concern, such as in women who are pregnant or in children (2)

Resources

(1) Renal or ureteric colic - acute - CKS (August 2020)

(2) Renal and ureteric stones: assessment and management. Imaging for diagnosis (2019)

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