In primary care, the management of suspected kidney stones involves arranging urgent (within 24 hours) imaging, preferably low-dose non-contrast CT for adults, or ultrasound for pregnant women and children/young people NICE NG118.
For pain relief, offer a non-steroidal anti-inflammatory drug (NSAID) by any route as first-line treatment NICE NG118.
If NSAIDs are contraindicated, not tolerated, or insufficient, offer intravenous (IV) paracetamol. If both are unsuitable or unavailable, consider an opioid analgesic such as tramadol NICE NG118.
Do not offer antispasmodics to people with suspected renal or ureteric colic NICE CKS.
Management options depend on factors such as stone size, location, severity of symptoms, and likelihood of spontaneous passage, including watchful waiting for stones less than 5 mm or if the patient prefers it after informed discussion NICE CKS,NICE NG118.
Consider medical expulsive therapy with alpha-blockers for distal ureteric stones less than 10 mm NICE CKS,NICE NG118.
Provide written information on renal and ureteric stones, and consider metabolic investigations such as serum calcium testing and stone analysis to identify treatable underlying conditions NICE CKS,NICE NG118.