When should I consider referring a patient with renal colic for specialist evaluation?

Consider referring a patient with renal colic for specialist evaluation urgently (within 24 hours) if they have signs of systemic infection or sepsis, such as fever, tachycardia, hypotension, or low temperature, which may indicate an obstructing stone with infection.

Immediate hospital admission and specialist referral are also warranted if the patient is at increased risk of acute kidney injury, for example, those with a solitary kidney, transplanted kidney, pre-existing chronic kidney disease, or suspected bilateral obstructing stones.

Refer urgently if the patient is dehydrated and unable to tolerate oral fluids due to nausea or vomiting.

When the diagnosis is uncertain, arrange immediate imaging and consider specialist referral to clarify diagnosis and management.

For children and young people with ureteric or renal stones, consider referral to a paediatric nephrologist or paediatric urologist for assessment and metabolic investigations.

Refer immediately for renal replacement therapy or nephrology input if acute kidney injury is complicated by pyonephrosis, obstructed solitary kidney, bilateral upper urinary tract obstruction, or if medical management fails to control hyperkalaemia, metabolic acidosis, uraemia symptoms, fluid overload, or pulmonary oedema.

For most other patients, arrange urgent imaging within 24 hours to confirm diagnosis and guide management, but specialist referral is primarily indicated by the above clinical features and risks.

These recommendations are based on NICE guideline NG118 (2019), CKS renal colic guidance, and NICE AKI guideline NG148 (2013) ¹,²,³,⁴.