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Suspected ureteric stone causing renal colic — MSRA MCQ

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ModerateNephrolithiasisSuspected ureteric stone causing renal colicMSRA

A 16-year-old girl presents to an urgent treatment centre with 6 hours of abrupt, severe left-sided colicky flank pain radiating to the groin and vomiting. She is afebrile and haemodynamically stable. Urine dipstick is positive for blood but negative for nitrites and leucocytes. Her estimated glomerular filtration rate is normal. A urine pregnancy test is negative. There is no history of renal disease or previous urolithiasis. Which is the most appropriate next diagnostic investigation?

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

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Correct answer: A — Arrange urgent low-dose non-contrast CT of the kidneys, ureters and bladder within 24 hours

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

This presentation is strongly suggestive of renal colic: abrupt colicky flank-to-groin pain, vomiting and haematuria, without features suggesting urinary infection. The decisive feature is that she is 16 years old. NICE defines children and young people as under 16 years; therefore, she falls within the adult imaging recommendation. In adults with suspected renal colic, urgent low-dose non-contrast CT should be offered within 24 hours. Her negative pregnancy test removes the principal reason to substitute ultrasound for CT in this age group. B is appropriate first-line imaging for suspected renal colic in patients under 16 years, and for pregnant patients regardless of age, but neither applies here. C may identify some radiopaque calculi but has inadequate diagnostic performance as a first-line test. D exposes her to unnecessary contrast and is not the recommended initial CT technique for suspected stones. E is inappropriate because imaging should not be delayed in an adult with suspected renal colic simply because observations and renal function are currently reassuring.

Reference: NICE NG118: Renal and ureteric stones: assessment and management — Recommendations, diagnostic imaging (Published 8 January 2019; last reviewed 26 February 2021) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations