How to identify and deal with a case of renal or ureteric colic in the emergency department? High risk population, clinical presentation, work up and initial management.

1. Renal/Ureteric Colic
Dima Lotfie

2. High risk stone formers
• Early onset
• Familial stone formation
• Hyperparathyroidism (high calcium or Vit D)
• Dehydration
• Gout
• Stagnation of urine (obstruction, strictures, reflux.. Etc)

3. Clinical presentation
• Symptoms
• Colicky flank pain:
Ø Intermittent
Ø Not related to position
Ø may radiate to the groin or lower abdomen
Ø Associated with dysuria and hematuria
• Physical exam
• Low abdominal tenderness
• costovertebral angle (CVA) tenderness

4. Diagnosis
• Diagnostic criteria
• based on clinical presentation and confirmed by lab and imaging
• Labs
1. Serum creatinine, uric acid, calcium, sodium, and potassium.
2. Urine studies: urinalysis/dipstick
• in order to check for RBCs:
Ø Hematuria: more than 5 per high-power field (hpf)
Ø Degree of hematuria is not predictive of stone size or likelihood of passage.
• White blood cells: Pyuria (>5 WBCs/hpf )
• Urine pH: urine pH greater than 7 suggests presence of urea-splitting
organisms, such as Proteus, Pseudomonas, or Klebsiella species
• Urine pH less than 5 suggests uric acid stones.
3. Urine culture

5. Imaging
1. KUB:
• 80% of stones are radiopaque
• IVP can be obtained too.

6. Imaging
2. Ultrasound:
• indication
• In patients who are pregnant and
children who are suspected to have
nephrolithiasis.
• Can identify radiolucent stones.
• Changes in renal parenchyma and
hydronephrosis.

7. Imaging
• Non-contrast CT:
has a sensitivity of 95-100% and
superior specificity and accuracy when
compared with IVP.

9. References
• Uptodate
• Medscape
• Medbullets