REMEDY : BNSSG referral pathways

Renal Calculi

Checked: 11-07-2018 by katy.kearley Next Review: 19-06-2019

Principles of Management

Refer to the CKS guidelines 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.

See also the local guidance for the management of acute renal colic produced by NBT. 

(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 ED if:

  • The person is in shock or has fever or other signs of systemic infection.

  • The person is at increased risk of acute kidney injury, for example if there is a solitary or transplanted kidney, pre-existing chronic kidney disease, or bilateral obstructing stones are suspected.

  • The person is pregnant.

  • The person is dehydrated and cannot take oral fluids due to vomiting.

  • There is uncertainty about the diagnosis (think AAA even if haematuria is present).

  • There is no response to symptomatic treatment within 1 hour (or sooner depending on clinical judgement), or there is a rapid recurrence of severe pain.

Referral Guidance

The Urology team at NBT have advised the following:

Acute Renal Colic

Refer patients with suspected acute renal colic to your local emergency department who can arrange urgent CT to confirm diagnosis and arrange follow up if necessary. Patients should not be referred to the Urology HOT clinic or surgical admission unit directly as they do not have access to urgent CT KUB scans via this service.

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 KUB (available on ICE). CKS suggests patients should be seen by a urologist within 7 days but this may not be achievable locally 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. If CT KUB confirms renal calculi then patients should be referred to the Urology Stone clinic via e-Referral (even if the patient is asymptomatic). In patients without proven calculus on CT then alternative diagnosis should be considered and referrals to urology may be rejected in these cases.