Renal Calculi

N20.0

DESCRIPTION

A kidney stone or calculus which has formed in the renal tract, i.e. pelvis, ureters or bladder, as a result of urine which is supersaturated with a stone-forming salt.

Clinical features of obstructing urinary stones may include:

  • sudden onset of acute colic, localized to the flank, causing the patient to move constantly,
  • nausea and vomiting,
  • referred pain to the scrotum or labium as the stone moves down the ureter.

Urinalysis usually reveals microscopic or macroscopic haematuria.

Stones may be passed spontaneously, or after medical or invasive treatment.

If available, collect the stones and send to the laboratory for analysis.

GENERAL MEASURES

Acute stage:

Oral fluids administered liberally.

Intravenous fluids to ensure adequate hydration and urine flow.

To prevent recurrence:

Avoid dehydration.

If recurrences occur, consult a specialist.

MEDICINE TREATMENT

Analgesia for renal colic:

  • NSAID, oral: e.g.

LoEI [26]

  • Ibuprofen, oral, 400 mg 8 hourly with meals.

Note: Avoid NSAIDs if renal impairment is present or suspected.

If patient is vomiting:

  • Diclofenac, IM, 75 mg as a single dose.

LoEIII

AND/OR

  • Tramadol, IM, 50–100 mg, 4–6 hourly.

LoEIII

OR

  • Morphine, IV, to a total maximum dose of 10 mg (See MORPHINE, IV, for individual dosing and monitoring for response and toxicity).

Currently, there is no convincing evidence to support the use of hyoscine in this setting.

For vomiting:

  • Metoclopramide, IM, 10 mg 8 hourly.

LoEIII

REFERRAL

  • In acute setting for suspected or diagnosed obstruction and/or ongoing pain.
  • Complicating urinary tract sepsis.
  • Recurrent calculi.