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, 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
Non-obstructive Stone
Surgery
Follow-up Evaluation
Repeat RBUS 1 month
Sooner if pain, nausea or vomiting
Not Passed
Passed
First Stone NOT High Risk
Normal Metabolic Evaluation
  • Recurrent Stone
  • First Stone AND High Risk
  • Cystine, Uric Acid or Rare Stones
Remain with Current Urology or Nephrology Provider
Nephrology Clinic
Consider
pharmacotherapy
  • 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
  • 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, August 2017
Authors: G. Tasian, MD; MSc, MSCE; L. Copelovitch, MD; N. Plachter, CRNP; K. Ashcroft, CRNP; S. Schneider, PA-C