Patient handout

Urolithiasis (kidney / ureteral stones)

PRODUCTION

1. Your condition

This handout is for urolithiasis (kidney / ureteral stones). Your care team identified this based on: sudden severe unilateral flank / cva pain ± groin radiation (aua 2016 pmid 27238616).

Other reasons your team may use this plan: renal colic with nausea / vomiting (aua 2016 pmid 27238616); hematuria + flank pain — stone vs uti vs pyelo (eau 2016 pmid 27506951); flank pain + fever + wbc → obstructing stone with infection (emergency — emergent decompression) (aua 2016 pmid 27238616).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ketorolac	30 mg IV (15 mg IV if eGFR 30–60 mL/min/1.73m²; avoid if eGFR <30 or active bleeding)	IV	q6h × ≤5 days	NSAID superior to IV morphine/paracetamol for renal colic at 30 min; ketorolac is the IV NSAID of choice (Pathan Lancet 2016 PMID 26993881)
morphine	0.1 mg/kg IV (typical 4–10 mg adult)	IV	q3–4h PRN	Breakthrough analgesia / NSAID-contraindicated patients (Pathan Lancet 2016 second-line)
ondansetron	4 mg IV	IV	q8h PRN	Antiemetic for renal colic-associated emesis (AUA 2016)
acetaminophen	1 g PO/IV	PO/IV	q6h scheduled, max 4 g/day adult	Opioid-sparing multimodal adjunct (AUA 2016)

Plan: Urolithiasis — acute analgesia + MET + obstruction-with-infection + composition-targeted prevention (AUA 2016 + EAU 2016)

3. When to call your provider

Contact your care team if any of the following happen:

New recurrent flank pain / fever / anuria → STAT ED (AUA 2016)
Abnormal 24-h urine + recurrence on prevention regimen → nephrology / urology multidisciplinary review (AUA 2016)
Hypercalcemia on follow-up → endocrine / parathyroid workup (AUA 2016)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Stone >10 mm — spontaneous-passage probability <20%; intervention indicated (AUA 2016)
Staghorn calculus (filling renal pelvis + calyces) — usually struvite; urease-producing organisms (AUA 2016)
Struvite stones (Mg-ammonium-phosphate) — staghorn shape; urease-producers (Proteus, Klebsiella, Pseudomonas, Providencia) on culture (AUA 2016)
Cystine stones — autosomal recessive cystinuria; hexagonal crystals on UA; positive cyanide-nitroprusside (AUA 2016)
Obstructing stone WITH infection (fever + WBC + UA leuk-esterase / nitrite + hydronephrosis) — UROLOGIC EMERGENCY (AUA 2016)(life-threatening)
Solitary functioning kidney OR transplant kidney with obstruction — emergent decompression regardless of infection (AUA 2016)
Bilateral ureteral obstruction with KDIGO ≥Stage 1 AKI — emergent decompression of at least one side (KDIGO AKI 2026 draft)

5. Follow-up

4–6 wk imaging follow-up (US or low-dose CT) to confirm passage; urology at 4–6 wk if non-passed; 24-h urine × 2 at 6 wk if recurrent (Curhan 2007 PMID 24857648); composition-targeted prevention (K-citrate / thiazide / allopurinol / alkalinization / tiopronin); hydration ≥2.5 L/d; Na <2 g/d (AUA 2016; EAU 2016)

6. Sources

Guideline: AUA/Endourological Society Surgical Management of Stones 2016 + AUA Medical Management of Kidney Stones 2014 (Pearle) + EAU MET for Ureterolithiasis 2016 (Türk) + SUSPEND MET RCT (Pickard Lancet 2015) + renal-colic analgesia RCT (Pathan Lancet 2016) + CT vs US NEJM (Smith-Bindman 2014)