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Acute Renal & Uretic Colic

 

Definition:  

Loin to groin pain associated with a calculus within the ureter. 

For chronic pain suggestive of a stone within the kidney, suggest renal USS which is a sensitive test for renal stones rather than follow this guidance including CT. 

 

Diagnosis: 

  • Severe, sudden onset loin pain, not associated with movement, typically intermittent waves, the patient “cannot get comfortable”.
  • Dipstick haematuria is strongly predictive 
  • Need to exclude peritonitis and aortic aneurysem.  

Management prior to referral: 

  • NSAID analgesia +/- opioids. 
  • If septic, ARF or pain uncontrolled admit urgently to RCH 
  • Request Urgent “CT-renal colic” (non-contrast CT-KUB, 97% sensitive: dose typically 5-10 MsV) to make diagnosis. 
  • If you are clinically unsure of diagnosis to expose patient to CT dose refer urgently to RCH. The NPV of USS and AXR is not good enough to use routinely in place of CT 
  • If pain controlled consider management in community; assay FBC/U&E/CRP  to assess sepsis/ARF, Urate and calcium. 
  • Refer for urgent OPA if stone apparent.  

 

Referral Information to include:

Previous Hx/ Fhx of stones, renal impairment or a solitary kidney

 

Reg Flags:

Send to RCH urgently if pain uncontrolled or evidence of sepsis or ARF/anuria