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Proposed Care pathway for Renal Colic (to be developed). High risk cases needing emergency 2 nd care assessment : Solitary functioning kidney Pyrexia +/- other signs of infection (such as peritonitis) Systemically unwell (hypovolaemia) +/- oliguria/anuria

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proposed care pathway for renal colic to be developed
Proposed Care pathway for Renal Colic(to be developed)
  • High risk cases needing emergency 2nd care assessment:
  • Solitary functioning kidney
  • Pyrexia +/- other signs of infection (such as peritonitis)
  • Systemically unwell (hypovolaemia) +/- oliguria/anuria
  • Possibility of ectopic pregnancy – delayed menstruation (consider gynaecological assessment
  • Age >60 yrs especially if no social support
  • Patients preference is for I/P care
  • If urinalysis –ve high suspicion of alternative diagnoses
  • (Other diagnoses - Cholylithiasis; pneumonia; pleurisy; PE; musculoskeletal; IBS; AAA; pancreatitis; perf DU; hydronephrosis (of other aetiology) and other renal diagnoses)
  • Identify high risk cases
  • Community management – (60% of ureteric calculi will
  • pass spontaneously)
  • - Assess pain – consider NSAID’s (PO/PR/IM) unless
  • contraindicated (then pethidine)
  • - Reassess pain after 1 hour and after 12-24 hrs (telephone
  • review adequate)
  • - If pain not controlled emergency admission to urology

History

/Exam.

(with typical unilateral pain, loin to groin, with haematuria (macro or micro) in 80-90%)

Investigations

Same day KUB

Patient consults GP

  • LLP Intermediate Urology Service
  • Outcome of assessment
  • If no calculus then consider alternative diagnosis – as above
  • If hydronephrosis or suspicion of malignancy then urgent urology referral
  • If non-obstructing ureteric/renal stone, medullar sponge kidney, duplex kidney
  • If stone <5mm 90% will pass spontaneously by 4 weeks
  • If stone >7mm 10% will pass spontaneously by 4 weeks

Urinalysis

Emergency admission to Urology

Rapid access imaging – IVU (unless contraindicated) OR un-enhanced spiral CT – If IVU contraindicated then either KUB + USS OR un-enhanced spiral CT

BP, pulse,

RR and temp

Routine Urology referral

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