🔪 General SurgeryRenal / UrologyStudentInternResident

Ureteric Colic & Renal Stones

Also known as: renal colic · urolithiasis · kidney stones · nephrolithiasis

Severe loin-to-groin colicky pain from a stone in the urinary tract, often with haematuria, nausea and a restless patient. Most small stones pass; the emergency is an obstructed, infected kidney.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Dehydration and hot climates, low fluid/high-oxalate diets, metabolic factors (e.g., hyperparathyroidism) and previous stones; commoner in men.

Red flags — escalate / refer

Fever/sepsis with an obstructing stone (infected obstructed system), a single or transplanted kidney, or acute kidney injury → urgent urological decompression.

Work-up / diagnosis

1Urinalysis (haematuria; check for infection) and renal function.
2Non-contrast CT of the kidneys, ureters and bladder (CT KUB) is the imaging of choice (ultrasound in pregnancy/children); note stone size and site.

Management — overview

Strong analgesia — an NSAID is first-line (an opioid if needed) — plus an antiemetic and good hydration.
Most stones under about 5 mm pass spontaneously; medical expulsive therapy (an alpha-blocker) can help a ureteric stone.
An infected obstructed kidney is an emergency needing urgent decompression (stent or nephrostomy) plus antibiotics.
Larger or persistent stones need a urological procedure (lithotripsy or ureteroscopy).

In-depthFull dosing & advanced protocol

Drug dosing

NSAID analgesia (first-line) ± opioid

Renal-colic pain

Adult dose: Per protocol; opioid if NSAID insufficient/contraindicated
Route: IM / IV / oral / rectal

Caution: NSAID caution in renal impairment/peptic ulcer.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Alpha-blocker (± antibiotics if infected)

Medical expulsive therapy; treat infection

Adult dose: Per protocol
Route: Oral / IV (antibiotics)

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

NSAID over opioid; the infected obstruction is the emergency

An NSAID gives better renal-colic analgesia than an opioid for most patients.
Non-contrast CT KUB is the gold-standard diagnostic test.
An infected, obstructed kidney needs emergency decompression — antibiotics alone are not enough.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute AppendicitisAcute inflammation of the appendix — the commonest surgical acute abdomen. Classically peri-umbilical pain that migrates to the right iliac fossa. Prompt surgery prevents perforation.Acute Cholecystitis & Biliary ColicInflammation of the gallbladder, usually from an obstructing gallstone — constant right-upper-quadrant pain, fever and a positive Murphy's sign. Biliary colic is transient pain from a stone WITHOUT inflammation.Acute Limb IschaemiaSudden loss of arterial perfusion to a limb — a surgical emergency. The 6 Ps: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis and Perishing cold. Muscle and nerve injury begin within hours.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

NSAID analgesia (first-line) ± opioid

Alpha-blocker (± antibiotics if infected)

📈 NSAID over opioid; the infected obstruction is the emergency

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

NSAID analgesia (first-line) ± opioid

Alpha-blocker (± antibiotics if infected)

📈 NSAID over opioid; the infected obstruction is the emergency

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

NSAID over opioid; the infected obstruction is the emergency

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

NSAID over opioid; the infected obstruction is the emergency

References