Suspected Nephrolithiasis (Kidney Stone)

Pathway Background and Objectives

Studies have demonstrated an increasing incidence of pediatric stone disease over the past 20 years. In addition, there has been a shift to outpatient care of patients with nephrolithiasis, particularly to the Emergency Department setting. Despite published national guidelines for the management of nephrolithiasis, there is regional variability in the use of CT scan as initial imaging modality. This pathway aims to establish a multidisciplinary team approach for the management of pediatric nephrolithiasis at CT Children’s. The specific objectives of this pathway are to:

  • Standardize the approach to evaluation of pediatric patients presenting for suspected nephrolithiasis (kidney stones)
  • Limit exposure to nephrotoxic medications in patients with abnormal serum creatinine level
  • Ensure appropriate referral/consult to subspecialty services when indicated
  • Appropriate use of radiographic studies
     

Algorithm  Educational Module

•    Percentage of patients seen in the ED who require admission
•    Percentage of patients who have serum Cr performed
•    Number of patients who undergo CT scan for stone evaluation in the ED
•    Percentage of patients returning to the ED within 48 hours after discharge
•    Percent of patients who received tamulosin for treatment of confirmed stone
•    Length of stay (LOS) in the ED for stone event

  1. Assimos D, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, Part I. J Urol. 2016 Oct;196(4):1153-60.  
  2. Pearle MS, et al. Medical Management of Kidney Stones: American Urological Association Guideline. J Urol. 2014 Aug;192(2):316-24.
  3. Carmen Tong CM, Ellison JS, Tasian GE. Pediatric Stone Disease: Current Trends and Future Directions. Urol Clin North Am. 2023 Aug;50(3):465-475. 

•    Leonela Villegas, MD, MSCE
•    Courtney Rowe, MD
•    Eric Hoppa, MD

 

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.