Renal and ureteric stones: a summary of recommendations from NICE

  • NICE

  • curated by Pavankumar Kamat
  • Clinical Guidance Summaries
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Guideline name: Renal and ureteric stones: assessment and management [NG118]

Update type: New guideline

Published: January 2019

Takehome

  • For adults with suspected renal colic, low-dose non-contrast CT is advised within 24 hours of presentation.

Diagnosis

  • For adults with suspected renal colic, low-dose non-contrast CT is advised within 24 hours of presentation. Ultrasound is advisable instead of CT for pregnant women.
  • For children and young people with suspected renal colic, the preferred first-line imaging is ultrasound within 24 hours of presentation. If ultrasound fails to provide a definitive diagnosis, consider low-dose non-contrast CT.

Pain management

  • First-line treatment of pain for adults, children and young people with suspected renal colic should be NSAIDs.
  • Antispasmodics are not recommended for pain relief.

Medical expulsive therapy

  • Alpha blockers are the drugs of choice for expulsion of distal ureteric stones

Surgical treatment

  • Adults with ureteric stones and renal colic may be referred for surgical treatment within 48 hours of diagnosis or readmission if the pain is continuous and intolerable or the stone is not likely to pass.
  • For asymptomatic renal stones in adults, children and young people, a watchful waiting is advisable
    • If the stone is
    • If the stone is >5 mm and an informed decision about watchful waiting is made with the patient/family/carers.

Paediatric Assessment

  • Children and young people with ureteric or renal stones should be referred to a paediatric nephrologist/urologist and for evaluation and metabolic testing.

Preventing recurrence

  • Dietary advice
    • Recommended daily water intake is 2.5-3 litres of water for adults, and 1-2 litres for children and young people (as per age).
    • Fresh lemon juice may be added to drinking water.
    • Carbonated drinks should be avoided.
    • Daily salt intake should be restricted to ≤6 g/day for adults, and 2-6 g for children and young people (as per age).
    • Recommended daily calcium intake is 700-1200 mg for adults, and 350-1000 mg for children and young people (as per age).
    • It is advisable to maintain a healthy weight to prevent recurrence of stones.
  • Potassium citrate is recommended for adults with recurrent stones that are primarily (>50%) calcium oxalate.
  • Potassium citrate is recommended for children and young people with recurrent stones that are primarily (>50%) calcium oxalate and with hypercalciuria/hypocitraturia.
  • Thiazides are recommended for adults with recurrent stones that are primarily (>50%) calcium oxalate and with hypercalciuria, following sodium restriction of ≤6 g a day.

This summary is reviewed by Prof. Rishabh Prasad MBBS, MA, MSC, FRCGP FRSA

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