Outpatient Specialty Care Clinical Pathway for the
Evaluation/Treatment of Children with Nephrolithiasis
Refer to ED if patient has:
- Suspected pyelonephritis
(fever & flank pain) - Vomiting
- Pain refractory to adequate oral analgesics
- ED Suspected Nephrolithiasis Pathway
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
- Ureteropelvic Junction Obstruction (UPJO), Posterior Urethral Valves (PUV), Duplex System, Bladder Exstrophy
- Lasix, Calcitriol, Topamax, steroids, antiretrovirals, vitamin use (C or D), ketogenic diet, Acetazolamide, Zonisamide
Non-emergent Referral for Stone Disease
Office Visit
- Detailed H & P
- Review Laboratory Studies and Imaging Consult Nephrology for Abnormal Results
Obstructive Stone
Call Urology
Call Urology
Non-obstructive Stone
Surgery
Follow-up Evaluation
Repeat RBUS 1 month
Sooner if pain, nausea or vomiting
Repeat RBUS 1 month
Sooner if pain, nausea or vomiting
Not Passed
Passed
First Stone NOT High Risk
Normal Metabolic Evaluation
- Recurrent stone or
First Non-calcium based stone
Remain with Current Urology or Nephrology Provider
Nephrology Clinic
Consider
pharmacotherapy
pharmacotherapy
- Follow-up Evaluation
- Every 6 months until
- 24-hour urine test is normal for 2 years
RBUS without stone
If above met, discharge from Kidney Stone Center - 24-hour urine test is normal for 2 years
Joint Urology/Nephrology Clinic
- 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
Posted: January 2013
Revised: October 2019
Authors: Tasian, G. MD, MSc, MSCE; Copelovitch, L. MD; Plachter, N. CRNP; Ashcroft, K. NP; Schneider, S. PA-C; Panus, J. RN
Revised: October 2019
Authors: Tasian, G. MD, MSc, MSCE; Copelovitch, L. MD; Plachter, N. CRNP; Ashcroft, K. NP; Schneider, S. PA-C; Panus, J. RN