Renal colic
Questionnaire/history:
Loin or flank pain radiating to groin or genitalia?
Pain usually severe, predominantly loin, groin or both; typically restless with the pain?
Vomiting?
Fever (sometimes)?
Urinary symptoms (distal stones often cause frequency, dysuria and urgency)?
Past medical history:
Diseases associated with stone formation?
Hypercalcaemic disorders eg hyperparathyroidism?
GI disease (eg Crohn's) & malabsorptive conditions incl. bariatric and bypass/resection surgery?
Recurrent UTI?
Gout?
Anatomical abnormalities eg polycystic kidneys, horseshoe kidney, vesico-ureteric reflux?
Differential diagnoses (eg ectopic, torsion, appendicitis, cholecystitis, pancreatitis, peritonitis, ruptured AAA (in people >50) and Assess for sepsis.
Examination:
Sepsis?
Investigation:
Urine dipstick (invisible haematuria seen in 80% to 85% of renal stones)
If signs of UTI, urine culture and start
Renal function
Urgent CT-KUB ideally within 24 hrs
Management:
NSAID (if nausea/vomiting PR route)
Opioids (eg tramadol), but less effective
Do NOT use antispasmodics
Anti-emetics if vomiting
Admit if:
Systematically unwell or febrile or a history of fever and rigors
Pain that does not settle within an hour of analgesia
Persistent nausea and vomiting, especially if dehydrated
If they have a solitary functioning kidney, have had a kidney transplant or are pregnant.
Stone expulsive therapy:
Consider alpha-blockers eg tamsulosin 400mcg daily
(Note: NICE recommend for distal stones < 10mm, EAU recommend for distal stones > 5 mm; in practice, we will not know size/position of stone but given low-risk profile of alpha-blockers treatment in primary care alpha-blockers should be considered unless contraindicated
Advised to return urgently if they develop fever or rigors, if the pain worsens or if they have rapid recurrence of severe pain
Common symptoms after stone intervention include haematuria, urgency, frequency, dysuria and flank pain (which likely settle)
If symptoms are persistent +/- severe or associated with systemic symptoms or urine retention stent migration needs to be considered
Alpha-blockers +/- anticholinergics can be tried for stent colic symptoms
Resource(s):