Proposed Care pathway for Renal Colic to be

Proposed Care pathway for Renal Colic (to be developed) • 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) History /Exam. Patient consults GP (with typical unilateral pain, loin to groin, with haematuria (macro or micro) in 80 -90%) • Identify high risk cases Same day KUB • 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 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 • Possibility of ectopic pregnancy – delayed menstruation (consider gynaecological assessment • Age >60 yrs especially if no social support • Patients preference is for I/P care Investigations LLP Intermediate Urology Service Urinalysis BP, pulse, RR and temp Rapid access imaging – IVU (unless contraindicated) OR un-enhanced spiral CT – If IVU contraindicated then either KUB + USS OR un-enhanced spiral CT 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 <5 mm 90% will pass spontaneously by 4 weeks If stone >7 mm 10% will pass spontaneously by 4 weeks Emergency admission to Urology Routine Urology referral