Outpatient Specialty Care Clinical Pathway for the
Evaluation/Treatment of Children with Nephrolithiasis
- Refer to ED if:
- Suspected pyelonephritis (fever and flank pain)
- Vomiting
- Pain refractory to adequate oral analgesics
- ED Nephrolithiasis Pathway
Child with Non-Emergent Referral to Urology or Nephrology for Nephrolithiasis
Specialty Care Office Visit
- History and Physical
- Review laboratory studies and imaging
- Begin metabolic evaluation
Obstructive Stone
Non-Obstructive Stone
Spontaneously passed stoneReview indications for surgery
Surgery Not Indicated
Surgery Indicated
- Tamsulosin or Doxazosin
- Repeat RBUS 1 mo or sooner if pain, nausea or vomiting
Stone passed
Stone not passed
Surgery
Consider Child Life consult
Review metabolic evaluation and reassess stone risk
- First calcium-based stone or stone composition unknown
- and
- Not high-risk
- and
- Normal metabolic evaluation
- Recurrent stone
- or
- First non-calcium-based stone
- or
- High-risk
- or
- Abnormal metabolic evaluation
Remain with current urology or nephrology provider
Joint Urology/Nephrology clinic
Potassium citrate, hydrochlorothiazide or chlorthalidone and other medications as indicated
- Every 6 mos until:
- 24-hr urine test is stable/normal and RBUS without stone for 2 yrs
- Then every year until normal for 2 yrs
- Consider discharge from Kidney Stone Center based on underlying pathology
- Consider referral to Nutrition, Psychology as indicated
- Every 3–6 mos until:
- 24-hr urine test is stable/normal and RBUS without stone for 2 yrs
- Then every year until normal for 3 yrs
- Consider discharge from Kidney Stone Center based on underlying pathology
- Consider referral to Nutrition, Psychology as indicated