Acute GP service

Management of ureteric/renal colic in the Acute GP service

 

 

History/examination

Patients with renal colic cannot get comfortable.

If happier lying still suspect alternative diagnosis

Exclude other pathology:

AAA

UTI

Musculoskeletal pain/back

Pregnancy

Exclude pyrexia/signs of systemic sepsis

 

Baseline investigations

Urine dip:         non visible haematuria supports diagnosis

                                    Nitrites suggests infection

 

FBC/U&E/Ca2+/urate (slight rise in wcc 13-14 is not uncommon and not of significance, 15+ may be.

Often transient rise in creatinine secondary to dehydration/NSAIDs).

If the patient has an eGFR < 30 refer to Contrast Protocol.

 

Imaging

CTKUB          97% sensitivity and specificity.

AXR(KUB)    if no scout film with CT, allows ease of follow up if stone visible.

If young/female and stone diagnosis in doubt consider uss as first line to reduce radiation dose.

If recurrent presentations with flank pain and/or recent diagnosis of stone may be worth discussion before repeating CT to reduce radiation exposure.

NB. Small stones in renal calyces do not generally cause pain. If no ureteric stone consider alternative diagnosis

 

Acute management

Analgesia:        diclofenac PR, morphine/antiemetic

Alpha blocker: Tamsulosin 400mcg od. May help stone passage and reduce analgesic requirements

RENAL DRAINAGE IS REQUIRED IN THE PRESENCE OF STONE AND PYREXIA/SEPSIS OR SINGLE KIDNEY. REFER EARLY TO ON CALL GENERAL SURGICAL TEAM/UROLOGY.

 

Suitable for discharge

Ureteric Stone 5mm or less diameter, pain controlled, no temperature.

TTA: analgesia and tamsulosin

Urology OPA 6 weeks with KUB xray on arrival(needs to be specified on outpatient request)

 

Criteria for admission

Ureteric stone >5mm

Uncontrolled pain

Sepsis/single kidney – see above

Impaired renal function