From the Research
The workup for a patient with renal colic should begin with a thorough history and physical examination, and imaging should be guided by the clinical scenario, with ultrasound being a suitable first-line imaging modality in many cases, as recommended by the most recent and highest quality study 1. The goal is to rule out other causes of abdominal pain and to confirm the diagnosis of renal colic.
- Start by assessing for red flags such as fever, lethargy, poor feeding, vomiting, diarrhea, or abnormal growth patterns that might indicate a medical condition rather than renal colic.
- Examine the patient completely, checking for signs of infection, or other causes of abdominal pain.
- Basic laboratory tests are not routinely needed but may include urinalysis, complete blood count, and stool studies if there are concerns for infection or inflammation.
- Consider ultrasound as the initial imaging modality, as it is a radiation-free, rapid, and cost-effective alternative to CT scanning, and it has been shown to be effective in diagnosing renal colic, particularly when using color Doppler ultrasound with twinkling 2.
- Ultrasound should be used as the first-line imaging modality in patients with suspected renal colic, unless there are specific clinical scenarios where CT is recommended, such as in patients with a high risk of complications or in whom ultrasound is inconclusive, as recommended by the most recent and highest quality study 1.
- For patients with suspected renal colic, the use of reduced-radiation-dose CT should be considered when CT is needed, as it can help to minimize radiation exposure while still providing accurate diagnostic information 3, 1.
- Parents or caregivers should be educated that renal colic typically resolves with supportive measures, including pain management and hydration, and that it is a common condition that can be managed effectively with appropriate diagnosis and treatment.