Pathway for the Outpatient Evaluation/Treatment of
the Child With Nephrolithiasis
Refer to ED if patient has:
HIGH RISK

FH of stone disease or renal failure

Known history of:
  • Bone disease, Inflammatory Bowel Disease (IBD),Cystic Fibrosis, Gout, Deafness, Failure to thrive (FTT), Seizure disorder, Immobility, Cerebral Palsy, Spina Bifida, Nephrectomy, Single kidney, Nephrocalcinosis
Urologic abnormality:
  • Ureteropelvic Junction Obstruction (UPJO), Posterior Urethral Valves (PUV), Duplex System, Bladder Exstrophy
Medication Exposure
  • Lasix, Calcitriol, Topamax, Steroids, Antiretrovirals, Vitamin Use (C or D), Ketogenic Diet
Non-emergent Referral for Stone Disease
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Office Visit
  • Detailed H & P
  • Review Laboratory Studies and Imaging Consult Nephrology for abnormal results
Obstructive Stone
Call Urology
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Non-obstructive Stone
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Surgery
Follow-up Evaluation
Repeat RBUS 1 month
Sooner if pain, nausea or vomiting
Not Passed
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Passed
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First Stone NOT High Risk
Normal Metabolic Evaluation
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  • Recurrent Stone
  • First Stone AND High Risk
  • Cystine, Uric Acid or Rare Stones
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Remain with current urology or nephrology provider
Nephrology Clinic
Consider
pharmacotherapy
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  • Follow-up Evaluation
  • Every 6-months until
    • 24-hour urine test is normal for 2-years
      RBUS without stone
    Then every year until 24-hour urine is normal twice If above met, discharge from Kidney Stone Center
Joint Urology/Nephrology Clinic
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  • Medications: Potassium Citrate, Hydrochlorothiazide or Chlorthalidone; other medications as indicated
  • Follow-up/Evaluation:
  • Every 6-months until
    • 24-hour urine is normal for 2-years RBUS without stone
    Then every year until normal for three years
Posted: January 2013
Revised: June 2015
Authors: G. Tasian, MD, MSc, MSCE; L. Copelovitch, MD; N. Plachter, CRNP; K. Ashcroft, CRNP; S. Schneider, PA-C