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

Goals and Metrics
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
Preparation for Office Visit
Office Visit
  • Detailed H & P
  • Review Laboratory Studies and Imaging Consult Nephrology for Abnormal Results
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: June 2015, August 2017, October 2019
Authors: Tasian, G. MD, MSc, MSCE; Copelovitch, L. MD; Plachter, N. CRNP; Ashcroft, K. NP; Schneider, S. PA-C; Panus, J. RN