Renal calculi

Summary: Urological referral not normally indicated for asymptomatic stones or for stones found incidentally. Symptomatic stones should be referred for an urological opinion

Advice: Urological referral not normally indicated for asymptomatic stones or for stones found incidentally. Symptomatic stones should be referred for an urological opinion
Refer To: Generic referral (to any urologist)

Contents:

Basic metabolic investigations

All patients require a basic metabolic screen, including the following investigations:

  • E&C
  • Bone function tests
  • Plasma urate
  • Spot urine for cystine
  • Stone analysis (if possible)

Back to Top

Additional metabolic tests

These are only required for patients < 40 years old, for those with multiple stones, for stone recurrence within 5 years of a previous stone or where there is a strong family history of stone disease. These should include:

  • 24-hour urine collection (acid) for calcium, oxalate, phosphate & citrate
  • 24-hour urine collection (plain bottle) for urate & sodium
  • early-morning urinary pH

See below for a flow chart outlining the required investigations.

Back to Top

Imaging of the urinary tract

This is best performed using computerised tomography (CT abdomen & pelvis). Ultrasound is inappropriate because it is insensitive at detecting ureteric calculi.

Click here to download a spreadsheet which aids the management of patients with renal colic.

Back to Top

Dissolution of stones

Dissolution of stones is not possible in the majority of patients. However, some patients with cystine, urate or matrix calculi can reduce their stone bulk using simple medical means. Contact Mr OJ Wiseman for further advice about specific medical treatment.

Back to Top

Prevention of further stone formation

This involves specific information about diet and fluid intake (see below for a printable information sheet).

Back to Top

Lithotripsy

Lithotripsy is the mainstay of treatment for the majority of renal calculi. Larger calculi may require percutaneous removal or, if the kidney is poorly-functioning, nephrectomy.

Ureteric stents are often inserted prior to lithotripsy for larger stones or when the stone(s) are blocking the drainage of the kidney. Ureteric stents cause significant symptoms (frequency, dysuria, haematuria & loin pain) in 80% of patients. Antibiotic treatment in these patients has no effect on stent symptoms but severe symptoms may be helped by NSAIDs.

Back to Top

Related Downloads

Back to Top

The cookie setting on this website is set to ‘allow cookies’ to give you the very best experience.

If you continue without changing this setting, you consent to this - but if you want, you can change your setting at any time using the ‘change cookie setting’ link at the bottom of this page.

Cookie Setting







Our Cookies

Cookie NamePurpose
eu_ask This is used to store the cookie setting you set in the form above.
If you choose 'Do Not Allow Cookies' we will need to store this information as a cookie with the value N.
If you choose 'Allow Cookies' or do not make a choice, we will store this information as a cookie with the value Y.

The value is kept for one year.

3rd Party Cookies

Cookie NamePurpose
Google Analytics This website uses Google Analytics, a web analytics service provided by Google, Inc.
Google Analytics sets a cookie in order to evaluate your use of the website and compile reports for us on activity on the website.
Google stores the information collected by the cookie on servers in the United States.
Google may also transfer this information to third parties where required to do so by law,
or where such third parties process the information on Google's behalf.
Google will not associate your IP address with any other data held by Google
By using this website, you consent to the processing of data about you by Google in the manner and for the purposes set out above.

How to reject or delete this cookie

http://www.google.com/intl/en/privacypolicy.html