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Suspected renal colic due to ureteric stone — MSRA MCQ

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ModerateHematuriaSuspected renal colic due to ureteric stoneMSRA

A 38-year-old woman presents to general practice with 4 hours of sudden, severe left-sided loin pain radiating to the groin. She is restless and has vomited once. She has no fever, dysuria, urinary frequency, vaginal bleeding or vaginal discharge. Her last menstrual period was 2 weeks ago and a urine pregnancy test is negative. Observations are normal. Abdominal examination shows mild left loin tenderness without guarding. Urine dipstick is 3+ blood, with negative nitrites and leucocytes. Creatinine is 76 micromol/L. She has no history of chronic kidney disease, peptic ulcer disease, anticoagulant use or NSAID-sensitive asthma. What is the most appropriate management plan today?

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Correct answer: C — Arrange urgent low-dose non-contrast CT within 24 hours and give an NSAID

This presentation is most consistent with suspected renal colic: acute severe unilateral loin pain radiating to the groin, restlessness, vomiting and haematuria, without features suggesting urinary infection or an alternative gynaecological diagnosis. She is an adult who is not pregnant, is clinically stable and has no stated contraindication to NSAID treatment. NICE recommends an NSAID as first-line analgesia and urgent low-dose non-contrast CT within 24 hours for adults with suspected renal colic. A is attractive because ultrasound avoids radiation, but it is first-line in pregnancy rather than in non-pregnant adults with suspected renal colic. B wrongly delays definitive imaging despite the recommended 24-hour timeframe. D uses an inappropriate CT protocol: CT urography is used principally for urothelial tract assessment rather than initial diagnosis of suspected stones. E reflects the need to investigate some haematuria presentations for malignancy, but the acute colicky pain pattern makes stone imaging the immediate priority; cystoscopy is not the initial investigation in this scenario.

Reference: Renal and ureteric stones: assessment and management (NG118), diagnostic imaging and pain management recommendations (2019; updated May 2026) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations