Referral Criteria for Patients with Kidney Stones

Emergency Department Referral Criteria

Patients with acute renal colic who cannot be assessed within 30 minutes should be sent to the emergency department 1, 2
Failure of pain control with analgesia within one hour requires immediate hospital admission 3
Patients with shock or fever must be admitted to hospital immediately due to risk of sepsis 1
Abrupt recurrence of severe pain after initial relief warrants immediate admission 3
Patients with a single kidney and acute obstruction should be referred to the emergency department 4
Abnormal vital signs, particularly tachycardia, hypotension, or fever, require emergency department referral 1
Patients over 60 years with flank pain should be referred to the emergency department to rule out abdominal aortic aneurysm 2
Women with delayed menses and flank pain should be referred to the emergency department to rule out ectopic pregnancy 2

Recurrent or extensive nephrolithiasis should be referred to a urologist 5, 6
Patients with solitary kidney and kidney stones should be referred to a urologist 4
Patients with bilateral obstructing stones should be referred to a urologist 4
The European Urology Association recommends medical expulsive therapy (alpha-blockers) for stones ≤10mm in the distal ureter 4

Diagnose based on history of abrupt onset of severe unilateral flank pain radiating to groin/genitals 1, 2
Perform urinalysis - presence of hematuria supports diagnosis (>80% of renal colic cases) 1
Administer analgesia promptly - diclofenac 75mg intramuscular injection is preferred 2
Follow up by phone within one hour to assess pain control 3
If pain is not controlled within one hour, arrange immediate hospital admission 3
All patients with suspected renal colic should receive follow-up imaging to confirm diagnosis 3
Patients managed at home should increase fluid intake and strain urine to catch any passed stones 3

Patients with known chronic kidney disease and nephrolithiasis should be referred to nephrology, as recommended by the American Journal of Kidney Diseases 5, 6
Patients with uric acid stones may benefit from oral chemolysis with urinary alkalinization, according to the European Urology association 4
Patients on antithrombotic therapy require special consideration before interventional procedures, as stated by the European Urology association 4