Nephrolithiasis Clinical Pathway — Outpatient Specialty Care

Outpatient Specialty Care Clinical Pathway for the
Evaluation/Treatment of Children with Nephrolithiasis

Goals and Metrics
Patient Education
Related 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
  • 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
Preparation for Office Visit
Office Visit
Obstructive Stone
Call Urology
Non-obstructive Stone
Indications for Surgery
Tamsulosin
Surgery
Follow-up Evaluation
Repeat RBUS 1 month
Sooner if pain, nausea or vomiting
Not Passed
Passed
Metabolic Evaluation
First Stone NOT High Risk
Normal Metabolic Evaluation
Abnormal Metabolic Evaluation
  • Recurrent stone or
    First Non-calcium based stone
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: December 2022
Authors: G. Tasian, MD, MSc, MSCE, J. Lee, MD, S. Schneider, PA-C; J. Panus, RN, L. Copelovitch, MD