Clinical Notes : Urology

50. Renal Colic


  • Peak incidence is in the summer due to dehydration

    • fluid intake <1L a day greatly increases risk

  • occurs in 5% to 15% of the population

    • Peak incidence at age 20 to 50

    • male:female 3:1

    • x3 higher incidence with a +ve Family History

  • Small ureteral stones (<10mm) usually pass spontaneously

    • 50% recurrence rate

  • Diseases associated with stone formation include

    • Hypercalcaemic disorders e.g. hyperparathyroidism

    • Gastrointestinal disease, especially malabsorptive conditions

    • After bariatric surgery

    • Recurrent UTI

    • Gout

    • Anatomical abnormalities e.g. polycystic kidneys



  • Pain

    • Acute or insidious onset

    • Loin, groin or loin to groin

    • Abdominal examination is usually normal

    • Classically “the worst pain ever”

    • Unable to get comfortable

  • Other possible associated symptoms

    • Dysuria, freq, urgency (especially distal stones)

    • Haematuria

    • Negative dipstick does NOT rule out renal colic

    • N&V

    • Fever/ rigors

  • Differential diagnosis

    • AAA (Abdominal Aoertic Aneurysm) if older +/- known cardiovascular risks. (This is easily missed!)

    • Appendicitis

    • Ovarian pathology

    • Testicular torsion



  • Refer to A+E if :

    • Previous AKI

    • Solitary kidney or transplanted kidney

  • NSAIDS first line

    • Consider 100mg PR diclofenac stat for pain rather than oral or IM analgesia

    • wait for 1 hr

    • refer to A+E if not settled after 1 hr

  • Antispasmodics (e.g. Buscopan)

    • conflicting evidence

    • No benefit from combining NSAID with antispasmodic

    • not recommended

  • Opioids if NSAID contraindicated

    • less effective than NSAIDs

    • α- blockers (e.g. nifedipine)

    • conflicting evidence

    • high doses required

    • not recommended

  • Prevention of recurrence (by up to 50%)

    • High fluid intake to produce > 2.5L urine / 24 hours

    • Reduce animal protein and avoid urate rich food (as in gout)

    • No need to restrict calcium (ineffective)

BMJ Best Practice.png

Therapeutic Approaches for Renal Colic in the Emergency Department: A Review Article

Samad EJ Golzari, Hassan Soleimanpour, Farzad Rahmani, Nahid Zamani Mehr, Saeid Safari, Yaghoub Heshmat, and Hanieh Ebrahimi Bakhtavar

Anesth Pain Med v.4(1). February 2014


Renal and ureteric stones: assessment and management

NICE guideline NG118

January 2019


Guidelines on urolithiasis

European Association of Urology




BMJ Best Practice

Last reviewed: February 2019

Last updated: September  2018


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