Management of ureteric/renal colic in the Acute GP service
Patients with renal colic cannot get comfortable.
If happier lying still suspect alternative diagnosis
Exclude other pathology:
Exclude pyrexia/signs of systemic sepsis
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.
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
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
Sepsis/single kidney – see above
Impaired renal function