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I enjoyed reading this review. However, the authors state that patients with renal colic who do not need immediate referral to hospital 'can be referred urgently as an outpatient to urology, ideally to a dedicated stone clinic having had appropriate imaging.' They advise that the best investigation is a CT scan.
I'm not what primary care is like in their area, but an urgent CT of renal tract is an impossibility, and even a plain X-ray involves a long and painful trip to the hospital then a 2 week wait for the result. So in our area, imaging prior to urgent outpatient referral is not a practical proposition.
Manjunath and colleagues outline a comprehensive approach to managing a patient with renal colic, in which diclofenac seems to be the NSAID of choice for initial pain relief. Indeed one has seen it being used extensively in the acute setting to good effect.
However, given recent conclusions from Medicines and Healthcare products Regulatory Agency (MHRA) about the cardiovascular safety of diclofenac, I’d be cautious for using it for patients with recurrent renal colic, with cardiovascular risk factors on a long term basis.[1] Diclofenac in daily doses of 150mg or more in comparison to other NSAIDs such as ibuprofen or naproxen is associated with a higher risk of arterial thrombosis (e.g. MI or stroke).
Re: Assessment and management of renal colic
I enjoyed reading this review. However, the authors state that patients with renal colic who do not need immediate referral to hospital 'can be referred urgently as an outpatient to urology, ideally to a dedicated stone clinic having had appropriate imaging.' They advise that the best investigation is a CT scan.
I'm not what primary care is like in their area, but an urgent CT of renal tract is an impossibility, and even a plain X-ray involves a long and painful trip to the hospital then a 2 week wait for the result. So in our area, imaging prior to urgent outpatient referral is not a practical proposition.
Competing interests: No competing interests