Recommended management of suspected kidney stones in primary care?

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 ³.

For pain relief, offer a non-steroidal anti-inflammatory drug (NSAID) by any route as first-line treatment ³.

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 ³.

Do not offer antispasmodics to people with suspected renal or ureteric colic ¹.

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 ¹,³.

Consider medical expulsive therapy with alpha-blockers for distal ureteric stones less than 10 mm ¹,³.

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 ¹,³.