Pathway for the Outpatient Evaluation/Treatment of
the Child With Nephrolithiasis
Non-emergent Referral for Stone Disease

Refer to ED if patient has:

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Obstructive Stone
Call Urology
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Non-obstructing Stone
or Stone Passed
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Surgery
  • Follow-up evaluation RBUS 1 month
  • Sooner if pain,
    nausea or vomiting
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Passed
Failed
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Stone Analysis
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No Stone Available
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Infectious
Stone
Cystine,
Uric Acid Stone
Calcium Phosphate/
Oxalate Stone
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Urologic
Management
Urine Culture
Surgery
Nephrology
Management
Number of
Prior Stones
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First Stone
Not High Risk
Recurrent Stone OR
First Stone AND High Risk
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Normal metabolic evaluation,
no stone
Normal metabolic evaluation, stone retained
Abnormal metabolic evaluation
Normal metabolic evaluation and high risk or recurrent stones
Prevention Teaching
Follow-up Evaluation
Prevention Teaching
Follow-up Evaluation
Prevention Teaching
Follow-up Evaluation
  • Refer to Stone Center (Urology)
  • RBUS, Litholink
  • Follow-up Intervals:
  • Yearly until evaluation is normal twice
  • Then every other year until evaluation is normal twice
If above met, D/C from
Stone Center
  • Refer to Stone Center (Urology)
  • RBUS, Litholink
  • Follow-up Intervals:
  • Follow-up every 6 months to monitor stone size and location
  • Refer to Stone Center (Nephrology)
  • RBUS, Litholink, Potassium Citrate
  • Hydrochlorothiazide, or Chlorthalidone
  • Follow-up Intervals:
  • Every 6 months until
    • Litholink normal twice
      RBUS without stone
  • Then evaluation per normal
    metabolic evaluation

HIGH RISK

FH of stone disease or renal failure

Known history of:

  • Bone disease, GI disease
  • Cystic Fibrosis, Gout, Deafness, Failure to thrive, Seizure disorder, Immobility, Cerebral Palsy, Spina Bifida, Nephrectomy, Single kidney nephrocalcinosis

Urologic abnormality:

  • UPJO, PUV, Duplex system,
  • Bladder Exstrophy

Medication Exposure

  • Lasix
  • Calcitriol
  • Topamax
  • Steroids
  • Antiretrovirals

Supplement or Vitamin Use

Ketogenic diet

Posted: January 2013
Revised: November 2014
Authors: G. Tasian, MD; MSc; L. Copelovitch, MD N. Plachter, CRNP