1. 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 to;
+ve result
:Definitive management
Action
Call on call Urology Spr
Call on call Urology Spr