Neobook — clinical reference

N20.0-2/N20.9/N21.0/N21.8/N21.9

DESCRIPTION

A kidney stone or calculus which has formed in the renal tract, i.e. pelvis, ureters or bladder, as a result of urine which is supersaturated with a stone-forming salt.

Clinical features of obstructing urinary stones may include:

sudden onset of acute colic, localized to the flank, causing the patient to move constantly,
nausea and vomiting,
referred pain to the scrotum or labium as the stone moves down the ureter.

Urinalysis usually reveals microscopic or macroscopic haematuria.

Stones may be passed spontaneously, after medical or invasive treatment.
If available, collect the stones and send to the laboratory for analysis.

GENERAL MEASURES

Acute stage:

Oral fluids administered liberally.
Intravenous fluids to ensure adequate hydration and urine flow.

To prevent recurrence:

Avoid dehydration.
If recurrences occur, consult a specialist.

MEDICINE TREATMENT

Analgesia for renal colic:

NSAID, oral: e.g.
- Ibuprofen, oral, 400 mg 8 hourly with meals.

LoE:IIb^xli

Note:

Avoid NSAIDs if renal impairment is present or suspected.

If patient is vomiting:

Diclofenac, IM, 75 mg as a single dose.

LoE:IVb

AND/OR

Tramadol, IM, 50–100 mg, 4-6 hourly.

LoE:IVb

Morphine, IV, to a total maximum dose of 10 mg (See Appendix II: Prescribing Information for Specific Medicines, for individual dosing and monitoring for response and toxicity).

Currently, there is no convincing evidence to support the use of hyoscine in this setting.

For vomiting:

Metoclopramide, IM, 10 mg 8 hourly.

LoE:IVb

REFERRAL

In acute setting for suspected or diagnosed obstruction and/or ongoing pain.
Complicating urinary tract sepsis.
Recurrent calculi.

Click here to access the pdf.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_17 October 2024

Chapter 7 Nephrology/Urological Disorders_7.3 Urological Disorders_7.3.8 Renal Calculi

Renal Calculi

Drugs mentioned

ICD-10 codes