Pathway for the Outpatient Evaluation/Treatment of the
Child with Nephrolithiasis

Non-emergent Referral for Stone Disease

Refer to ED if patient has:

arrow
arrow
Obstructive or
Non-obstructive Stone ≥ 5 mm
Call Urology
Obstruction is defined as: ureteral stone with dilation of ureter and/or pelvicaliceal system and/or persistent nausea, vomiting and/or pain.
arrow
arrow
arrow
arrow
arrow
Non-obstructing Stone < 5 mm
or Stone Passed
arrow
arrow
Surgery
arrow
Stone Analysis
arrow
No Stone Available
arrow
Follow-up Evaluation
RBUS 1 month
arrow
arrow
arrow
Infectious
Stone
Cysteine,
Uric Acid Stone
Calcium Phosphate/
Oxalate Stone
arrow
arrow
arrow
Urologic
Management
Nephrology
Management
Number of
Prior Stones
arrow
arrow
First Stone
Not High Risk
Recurrent Stone OR
First Stone AND High Risk
arrow
arrow
arrow
arrow
arrow
arrow
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
RBUS, Litholink, Urology
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
  • Follow-up every 6 months to monitor stone size and location
RBUS, Litholink, Urology
Follow-up Intervals:
Refer to Stone Center
(Nephrology) RBUS, Litholink
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
Authors : G. Tasian, MD, MSc, L. Copelovitch, MD N. Plachter, CRNP
References