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Home | Articles | Renal | Ureteric Colic & Renal Stones

Ureteric Colic & Renal Stones

Last updated 30th March 2022

Clinical Presentation

  1. Classically pain from loin to groin, testes or vulva, often with nausea, vomiting & sometimes frank haematuria
  2. Patients over 55 years with no other urinary symptoms – consider acute abdominal aortic aneurysm and get urgent surgical opinion.

Types of Stone

  1. Calcium stones 80% – due to hypercalciuria which may in turn be due to hyperparathyroidism, RTA or idiopathic
  2. Uric acid stones 10% – see causes of gout.
  3. Infection stones 5% – chronic infection with urea splitting organisms causes stones made of magnesium ammonium phosphate and calcium phosphate
  4. The rest 5% – eg cystine stones

Investigations

  1. Urinalysis – if not even a trace of blood then diagnosis is in doubt
  2. CT KUB scan should be requested next working day for all patients except women of child bearing age who should have US.
  3. If CT shows stone, request KUB X-ray as baseline for follow up as 70% stones are radio-opaque.
  4. Exclude infection – temp, routine bloods and MSU,
  5. Stone screen only indicated for recurrent stone formers – U&E including serum bicarbonate, Ca, PO4, Urate
  6. Added value of 24 hour urines and stone analysis is so low that we dont request very often.

Treatment of Acute Attack

  1. Adequate analgesia with NSAIDs eg ibuprofen ± opiates
  2. Adequate hydration – usually with IV fluids
  3. Exclude obstruction (hydronephrosis) by CT KUB
  4. Exclude infection as above
  5. Obstruction with infection (pyonephrosis) is an emergency requiring urgent percutaneous nephrostomy/stenting and broad spectrum antibiotics – discuss with consultant
  6. Obstruction without infection may require lithotripsy or ureteroscopy (open surgery no longer performed for ureteric stones)

Prevention of Stone Recurrence

  1. Mainstay of prevention is high fluid intake to maintain urine volume 2.5 to 3 litres per day.
  2. Eradicate chronic infection if present
  3. Correct underlying causes eg hyperparathyroidism, RTA and gout if present;
  4. Dietary measures – avoid excess oxalate (rhubarb, spinach). NB low dietary calcium (dairy products) may cause increased absorption of oxalate which increases risk of stone formation. Avoid high purine foods if uric acid stones
  5. Alkalinise urine with potassium citrate sometimes recommended for stones eg uric acid that are more likely to precipitate in acidic urine
  6. Thiazides inhibit calcium excretion and are sometimes recommended for hypercalciuric stone fromers

Content updated by Ian Russell