Patients with suspected stones should be referred to secondary care.
They can be investigated with a CT KUB (non-enhanced stone CT).
All patients should have FBC/ U&Es / Bone profile and Urate (SUA) levels.
MSU must be sent
Consider renal tract stones in patients with Proteus/Pseudomonas and Klebsiella UTI without catheters
Acute ureteric colic should be referred to ED or for an urgent Urology appointment if there is recent history of ureteric colic (request an urgent CT KUB). Please mention in the urology referral that you have requested a scan.
Irreversible renal damage can probably occur within three weeks of complete obstruction.
Acute management is with rectal diclofenac 100mg, antiemetic and tamsulosin 400mcg daily until the stone passes. A concern is that by managing the pain well, an obstructed kidney will become less painful and tolerable. Then there will not be timely intervention, so resulting in permanent renal damage.
Do not rely on an ultrasound to prove or disprove stones. Many stones do not show up on ultrasound, although ultrasound is good at detecting obstruction in the form of hydronephrosis.
Most stones show up on a plain KUB xray.
Most stones cause some haematuria.
Not all stones give pain.