- Document type
- n/a
- Place
- South and West Hertfordshire
- Output type
- Clinical Pathways
- Pathway
- Loin Pain Renal Colic Pathway
Loin Pain Renal Colic
Pathway Publish Date: October 2024
Pathway Next Review Date: October 2026
- Renal or ureteric colic generally describes an acute and severe loin pain caused when a urinary stone moves from the kidney or obstructs the flow of urine.
- It is common, with an annual incidence of 1–2 cases per 1000 people. Recurrence rates are high.
- Assessment of a person with suspected renal or ureteric colic should include:
- Asking about symptoms. The main symptom is severe, unilateral abdominal pain starting in the loin or flank and radiating to the labia in women or the groin or testicle in men. Pain is often accompanied by nausea, vomiting, and haematuria.
- Identifying risk factors, such as chronic dehydration, family history, gastrointestinal conditions (such as Crohn's disease), and the use of certain medications (such as protease inhibitors).
- Performing an abdominal examination to help exclude differential diagnoses, such as appendicitis or diverticulitis.
- Assessing for signs of complications, such as hesitancy of micturition or an intermittent urinary stream (suggesting urinary tract obstruction) and fever and sweats (suggesting coexisting urinary tract infection).
- Immediate hospital admission should be arranged if:
- The person has signs of systemic infection or sepsis.
- The person is at increased risk of acute kidney injury, for example, if they have pre-existing chronic kidney disease or a solitary or transplanted kidney, or if bilateral obstructing stones are suspected.
- The person is dehydrated and cannot take oral fluids due to nausea and/or vomiting.
- There is uncertainty about the diagnosis.
- For all other people with suspected renal or ureteric colic:
- Urgent (within 24 hours of presentation) imaging should be offered.
- Management of urinary stones depends on factors such as the size of the stone, severity of symptoms, location of the stone, and the age of the person. Options include watchful waiting, medical expulsive therapy, and surgical treatment.
Please see pathway attached.