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Suspected renal colic in pregnancy — MSRA MCQ

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HardHematuriaSuspected renal colic in pregnancyMSRA

A 29-year-old woman who is 32+4 weeks pregnant presents with 5 hours of sudden severe right-sided loin pain radiating to the groin. She has vomited twice and is unable to find a comfortable position. She has no fever, dysuria, urinary frequency, vaginal bleeding, uterine tightening or reduced fetal movements. Her temperature is 36.8°C, blood pressure is 118/70 mmHg and pulse is 88 beats/minute. There is right renal angle tenderness without peritonism. Urine dipstick is 3+ blood, with negative nitrites and leucocytes. Her eGFR is 94 mL/min/1.73 m². What is the most appropriate management today?

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

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Correct answer: A — Arrange same-day hospital assessment for urgent renal tract ultrasound and give intravenous paracetamol

This presentation is strongly suggestive of renal colic: abrupt severe loin-to-groin pain, restlessness, vomiting, renal angle tenderness and haematuria, without features suggesting urinary infection or obstetric pathology. Imaging is needed urgently rather than after a trial of community analgesia. For adults with suspected renal colic, NICE recommends low-dose non-contrast CT within 24 hours; pregnancy is the explicit exception, for which ultrasound should be offered instead. Although NSAIDs are ordinarily first-line analgesia for renal colic, they should be avoided in pregnancy, particularly in the third trimester. As NSAIDs are contraindicated here and her pain is severe with vomiting, intravenous paracetamol is the recommended next analgesic option. B applies the usual non-pregnant renal-colic pathway but exposes the fetus to ionising radiation and uses an inappropriate analgesic. C correctly selects ultrasound but incorrectly gives an NSAID at 32 weeks' gestation. D uses an imaging modality that is not NICE first-line imaging for suspected renal colic in pregnancy. E underestimates the severity of suspected renal colic and fails to arrange imaging within the recommended urgent timeframe.

Reference: NICE NG118: Renal and ureteric stones: assessment and management — Recommendations (2019; last reviewed 2021) — https://www.nice.org.uk/guidance/ng118/chapter/recommendations NICE NG118: Renal and ureteric stones: assessment and management — Pain management (2019; last reviewed 2021) — https://www.nice.org.uk/guidance/ng118/chapter/recommendations NICE QS195: Renal and ureteric stones — Quality statement 2: Pain management (2020) — https://www.nice.org.uk/guidance/qs195/chapter/Quality-statement-2-Pain-management