Condition: Renal Calculi
Section Author: Jon Rees
Review Date: September 2017
A common issue in primary care – kidney stones.
There are a few key issues for the GP:
- How to manage acute renal colic – who to admit, what analgesia and imaging if not admitting
- When to refer asymptomatic stones
- Advice on preventing further calculi, especially for recurrent stone formers
Healthcare Professional Links
Management of renal colic – review in BMJ 2012: http://www.bmj.com/content/345/bmj.e5499
SUSPEND trial – randomised controlled trial from UK, published n 2015 – showed no benefit of ‘medical expulsive therapy’ such as tamsulosin, to aid passage of calculi: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60933-3/fulltext?rss%3Dyes (free – open access)
EAU guidelines on nephrolithiasis 2015 – if you really want to know the detail – 71 pages: http://uroweb.org/wp-content/uploads/22-Urolithiasis_LR_full.pdf
BJU International ‘Guideline of Guidelines: Kidney Stones’: http://onlinelibrary.wiley.com/doi/10.1111/bju.13080/full - an excellent review of both the EAU and AUA guidelines, published in 2015.
Advice on fluid management: http://www.cystinuriauk.co.uk - this website is intended for patients with cystinuria - rare complaint – but excellent guidance in the ‘Diet – tell me more’ section on how to maintain a good fluid intake.
Preventing kidney stones – excellent patient information sheet from Guys & St Thomas’s written by Matt Bultitude and the hospital dietitians – well worth signposting patients towards this: http://www.guysandstthomas.nhs.uk/resources/patient-information/urology/stones/diet-and-lifestyle-advice-for-the-prevention-of-kidney-stones.pdf
BAUS info sheet for patients on ‘dietary advice for stone formers’: http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Stone_diet.pdf
A detailed blog on ‘the kidney stone diet’ – worth a look for recurrent stone formers: http://kidneystones.uchicago.edu/the-kidney-stone-diet/
What activities are safe with kidney stones? Short paper with useful advice re DVLA, pilots, foreign travel, armed services etc: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2007.06553.x/full
Information for patients
NHS Choices http://www.nhs.uk/Conditions/kidney-stones/Pages/Introduction.aspx