Often unable to lie still Exclusion of other causes Think AAA Guideline for Management of Acute Renal Colic in North Bristol Trust ( April 2014) Reviewed (April 2016) Symptoms and signs of renal colic lateral pain with radiation to groin or genitalia Often unable to lie still Exclusion of other causes Think AAA 10% present as ‘renal colic’ may have haematuria (renal artery involvement) ABC, urgent surgical advice Diagnosis Urinalysis: haematuria (in 90%) β HCG in ALL premenopausal women Nitrites suggests UTI Bloods: fbc, U & E, ca, uric acid Investigation Initial management Antiemetics: eg. metoclopramide/cyclizine/ ondansetron Analgesia: Paracetamol, NSAIDs eg diclofenac 100mg PR (caution: renal impairment, asthma etc.) opiates (avoid pethidine) Note: Referrals will not be accepted without a proven calculus on CT Imaging CTKUB Urgent if: Sepsis/fever Suspected anatomically/functionally solitary kidney -ve result Reconsider diagnosis, discharge or refer as appropriate EMERGENCY Obstructing calculus in a single or transplanted kidney OR obstruction with signs of infection (especially pyrexia) URGENT Consider urology referral if •Renal dysfunction •Bilateral obstruction •Pain not settling with adequate analgesia •Stone size ≥6mm (may warrant acute lithotripsy) OUTPATIENT Consider discharge if; Pain settled Stone <6mm Discharge with Analgesia Tamsulosin 400 mcg OD for 2/52 Arrange plain KUB in addition to CT (helps with follow up) Complete Southmead stone referral form and email to; urinarystonereferrals@nbt.nhs.uk +ve result :Definitive management Action Call on call Urology Spr Call on call Urology Spr