Crystalline stone formation within the urinary tract, typically calcium oxalate, presenting with renal colic.
Investigations
- • Non-contrast CT KUB (gold standard)
- • Urinalysis, urine culture, U&E, calcium, urate
- • Stone analysis and 24 h metabolic screen if recurrent
Management
- • Analgesia: NSAID (diclofenac 75 mg IM) first line, opioid if contraindicated
- • Hydration and antiemetics
- • Medical expulsive therapy (tamsulosin) for distal stones 5–10 mm
- • Urgent decompression if obstructed and infected — nephrostomy or stent
Prevention
- • Fluid intake 2.5–3 L/day
- • Reduce sodium and animal protein, maintain normal dietary calcium
- • Thiazide for hypercalciuria, potassium citrate for hypocitraturia, allopurinol for uric acid stones
Clinical pearls
- • Fever plus obstructing stone is a urological emergency
- • Stones <5 mm pass spontaneously in ~80%
Related in WardRound
Educational — verify locally.
