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Ureteric stone after spontaneous passage — MSRA MCQ

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ModerateNephrolithiasisUreteric stone after spontaneous passageMSRA

A 52-year-old man is reviewed by his GP 2 weeks after his first CT-confirmed ureteric stone. He passed the 4 mm stone spontaneously and has retained it in a clean container. His symptoms have resolved, renal function is normal, and CT showed no residual stones. He has no family history of stone disease, bowel disease or recurrent urinary infection. No serum calcium was measured during his emergency department attendance. What is the most appropriate routine follow-up investigation plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Send the retrieved stone for analysis and measure serum calcium

Explanation lettering: E = shown as A · A = shown as B · B = shown as D · D = shown as E

NICE recommends measuring serum calcium in all adults with renal or ureteric stones, either at presentation or follow-up, to identify a potentially treatable hypercalcaemic cause such as primary hyperparathyroidism. It also recommends considering stone analysis in adults with renal or ureteric stones. This patient has an available retrieved specimen and did not have calcium measured acutely, so both actions should now be taken. A and B are attractive because 24-hour urine testing can identify abnormalities such as hypocitraturia or hypercalciuria, particularly in recurrent stone formers. However, NICE found insufficient evidence to make a routine practice recommendation for full 24-hour metabolic urine testing, including after recurrent calcium oxalate stones. D includes the mandatory serum calcium measurement but omits stone analysis; parathyroid hormone testing would usually follow an abnormal calcium result rather than be used as a routine initial test. E is inappropriate because lifestyle advice should be given, but it does not replace serum calcium measurement and consideration of stone analysis.

Reference: NICE NG118: Renal and ureteric stones: assessment and management — Recommendations (Published 8 January 2019; checked 15 August 2026) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations NICE NG118: Renal and ureteric stones: assessment and management — Rationale and impact (Published 8 January 2019; checked 15 August 2026) — https://www.nice.org.uk/guidance/ng118/chapter/Rationale-and-impact