Renal stones: management Acute management of renal colic Medication the British Association of Urological Surgeons (BAUS) recommend diclofenac (intramuscular/oral) as the analgesia of choice for renal colic* BAUS also endorse the widespread use of alpha-adrenergic blockers to aid ureteric stone passage Imaging patients presenting to the Emergency Department usually have a KUB x-ray (shows 60% of stones) the imaging of choice is a non-contrast CT (NCCT). 99% of stones are identifiable on NCCT. Many GPs now have direct access to NCCT Stones < 5 mm will usually pass spontaneously. Lithotripsy and nephrolithotomy may be for severe cases. Prevention of renal stones Calcium stones may be due to hypercalciuria, which is found in up to 5-10% of the general population. high fluid intake low animal protein, low salt diet (a low calcium diet has not been shown to be superior to a normocalcaemic diet) thiazides diuretics (increase distal tubular calcium resorption) Oxalate stones cholestyramine reduces urinary oxalate secretion pyridoxine reduces urinary oxalate secretion Uric acid stones allopurinol urinary alkalinization e.g. oral bicarbonate *Diclofenac use is now less common following the MHRA warnings about cardiovascular risk. It is therefore likely the guidelines will change soon to an alternative NSAID such as naproxen
Posted on: Fri, 16 Aug 2013 18:55:10 +0000
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