How should I manage a patient with a small, asymptomatic kidney stone?

Management of a small, asymptomatic kidney stone:

For adults, children, and young people with an asymptomatic renal stone less than 5 mm, watchful waiting is recommended as the first-line management approach.

This involves monitoring the patient without immediate intervention, as small stones under 5 mm often pass spontaneously and may not cause symptoms.

If the stone is larger than 5 mm, watchful waiting may still be considered if the patient (or their family or carers) agrees after an informed discussion about the possible risks and benefits.

Medical expulsive therapy with alpha-blockers is generally considered for distal ureteric stones less than 10 mm to facilitate spontaneous passage, but is not routinely indicated for asymptomatic renal stones.

Metabolic investigations, including measuring serum calcium and considering stone analysis, are recommended to identify any underlying treatable conditions such as primary hyperparathyroidism or cystinuria.

Patients should be advised on lifestyle and dietary measures to prevent recurrence, including adequate hydration (2.5 to 3 litres of water daily for adults), avoiding excessive salt intake, and maintaining normal calcium intake.