What are the recommended initial investigations for a patient presenting with suspected kidney stones?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For patients presenting with suspected kidney stones (renal or ureteric colic), the recommended initial investigations primarily involve urgent imaging ,,.

  • Urgent Imaging: Imaging should be arranged urgently, within 24 hours of presentation, to confirm the diagnosis and assess the likelihood of spontaneous stone passage ,,.
    • For most adults, low-dose non-contrast CT (computed tomography) is offered ,,.
    • If a woman is pregnant, ultrasound is offered instead of CT ,,.
    • For children and young people, ultrasound is offered first-line ,,. Low-dose non-contrast CT may be considered if there is still uncertainty about the diagnosis after an ultrasound scan ,,.
  • Metabolic Investigations: Metabolic investigations are also recommended to determine the type of stone and any potential underlying causes ,. For adults with ureteric or renal stones, stone analysis and measurement of serum calcium should be considered .

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