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
- Additional metabolic tests
- Imaging of the urinary tract
- Dissolution of stones
- Prevention of further stone formation
- Lithotripsy
- Related downloads
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)
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.
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.
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.
Prevention of further stone formation
This involves specific information about diet and fluid intake (see below for a printable information sheet).
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.
Related Downloads
- Miscellaneous: Advice to patients with an ureteric stent (228 KB)
- Specific Disorders: Dietary advice for stone formers (253 KB)
- Diagnostic Tests: Metabolic screening flowchart (146 KB)