Kidney stone disease: an update on its management in primary care

WHY WAS THIS UPDATE DEVELOPED?

The incidence of kidney stone disease (urolithiasis) is rising, with a lifetime risk of 10–15%, and a recurrence rate of 50% within 10 years.¹ Associated complications include significant pain secondary to renal colic, urinary tract infection (UTI) and urosepsis, and chronic kidney disease. The increasing burden of urolithiasis means that optimising its management in primary care is important.

WHEN TO REFER FOR ACUTE RENAL COLIC

Patients with suspected renal colic (colicky intermittent abdominal and/or flank pain, and haematuria), with no known history of urinary stones, should be offered urgent imaging within 24 hours.² If signs of a possible UTI are present, initial management should include empiric antibiotics, and urine should be sent for culture. Non-contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) is the first-line investigation (sensitivity ∼95%, specificity ∼98%); however, ultrasound is indicated for children and pregnant women (sensitivity ∼84%, specificity ∼53%).³ Patients with known urinary stones also require urgent referral if their pain is uncontrolled with oral analgesia, or if they have signs of sepsis.

For patients whose symptoms have settled, less urgent imaging can be requested, as long as there are no other clinical concerns. Renal function should also be checked.

WHAT TO DO FOR PATIENTS BEING MANAGED CONSERVATIVELY

Stones <4 mm have a …