GuidelinesPrimary Care STG
Renal Calculi
Urology
N20.0-2/N20.9/N21.0/N21.8/N21.9
DESCRIPTION
This is 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 respect to a stone-forming salt.
Clinical features of obstructing urinary stones may include:
- Sudden onset of acute colic, localised to the flank, causing the patient to move constantly,
- Nausea and vomiting,
- Referred pain to the scrotum or labium on the same side as the stone moves down the ureter,
Urinalysis usually reveals microscopic or macroscopic haematuria.
GENERAL MEASURES
- Ensure adequate hydration.
MEDICINE TREATMENT
Adults:
Analgesia for pain, if needed:
- Morphine, IM, 0.1 mg/kg 30 minutes before aspiration procedure, to a maximum of 10 mg (Doctor initiated).
LoE:IVb
REFERRAL
- Referral, even with a single first stone episode:
- All patients < 19 years of age.
- Pregnant woman (refer postpartum).
- Morbidly obese patients.
- Patients known to have polycystic kidney disease.
- Patients with inherited metabolic disorders of kidney function (e.g. Fanconi syndrome, and inherited conditions resulting in renal tubular acidosis or nephrolithiasis).
- Referral (for metabolic work-up to identify the cause and provide treatment in order to limit future episodes) to a nephrologist is indicated as follows:
- Patients with first episode of multiple stones in both kidneys.
- Patients with three or more kidney stone episodes within 2-3 years.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_17 October 2024
Chapter 8: Kidney and Urological Disorders_8.11 Renal Calculi