Acute loin-to-groin pain from ureteric obstruction by a calculus.
Investigations
- • Non-contrast CT KUB within 14 h (immediately if fever or single kidney)
- • Urine dip for blood, MSU
- • U&E, calcium, urate, FBC, CRP
- • Pregnancy test — use ultrasound instead
Management
- • Diclofenac 75 mg IM/PR as first-line analgesia
- • IV fluids and antiemetics
- • Stones <5 mm usually pass; tamsulosin for distal stones 5–10 mm
- • Urgent decompression (nephrostomy or stent) if infected obstructed kidney
- • Metabolic work-up for recurrent stones
Complications
- • Infected obstructed system — urological emergency
- • Acute kidney injury in a single kidney
- • Recurrence in 50% within 10 years
Clinical pearls
- • Fever plus obstruction requires decompression, not just antibiotics
- • Consider ruptured AAA in patients over 60 with first presentation
Related in WardRound
Educational — verify locally.
