UROLOGY

ResponseRenal colic - Renal angle tenderness, tachycardia, absence of fever or low grade
Pyelonephritis - fever, tachycardia, hypotension. Renal angle tenderness
AAA - pulsatile mass, bruit. Hypotension
L1-L2 radicular pain - Midline back pain, neurology
Basal pneumonia - Fever, creps, hpoxia
Renal artery embolism/aneurysm - AF, renal artery embolism, high/low BP

ResponseXR KUB

• Available, lower radiation than CT, good for follow up for radioopaque stones
• ?Calculi vs phlebolith. Not all stones radioopaque

CTKUB

• No contrast, non renal causes to be assessed
• Radiation (Cumulative with recurrent stones), unstable pt not suitable for scan

US

• No radiation, no contrast, safe in pregnancy, non invasive
• Stone not always visualised, not available out of hours

IVP

• Historically gold standard. Non functionin kidney (AAA, renal Art. embolism/thrombus), + distal obstruction
• Contrast allergy, renal injury from contrast, time consuming. Contraindicated in myeloma

MRI

• No radiation
• Poorly available to ED,

ResponseUrine dipstick/MCS - exlude urinary infection which would require stent
urea/creatanine - ? AKI as complication of obstruction

ResponseLocation, side and size (small, large etc as you won’t be able to measure)
Hydroureter/hydronephrosis
Fat stranding

ResponseSole kidney
Pain not controlled/failure to settle
UTI
High degree of obstruction/Large stone requiring surgery (>7mm)
Time of day, not coping at home, social stuff etc.

ResponsePain well managed
No UTI
Tolerating oral intake
Follow up arranged