What criteria should I use to determine whether to refer a patient with kidney stones for specialist evaluation?

Refer a patient with suspected renal or ureteric stones for specialist evaluation if they have signs of systemic infection or sepsis, such as fever, tachycardia, or hypotension, which may indicate an obstructing stone with infection ¹.

Patients at increased risk of acute kidney injury, such as those with pre-existing chronic kidney disease, a solitary or transplanted kidney, or bilateral obstructing stones, should be referred urgently ¹.

If the patient is dehydrated and cannot tolerate oral fluids due to nausea or vomiting, they require urgent specialist assessment ¹.

Patients with uncertain diagnosis after initial assessment should be referred for specialist evaluation to arrange urgent imaging and confirm the diagnosis ¹.

In cases where urgent imaging (within 24 hours) is indicated, such as suspected renal colic, and diagnosis remains uncertain, referral is appropriate for further management ¹.