Education And Debate

Managing acute renal colic across the primary-secondary care interface: a pathway of care based on evidence and consensus

BMJ 2002; 325 doi: (Published 14 December 2002) Cite this as: BMJ 2002;325:1408
  1. P J Wright, general practitioner (⇑,
  2. P J English, consultant urologistb,
  3. A P S Hungin, professor of primary care and general practicea,
  4. S N E Marsden, consultant radiologistb
  1. aWolfson Research Institute University of Durham, Queens Campus, University Boulevard, Stockton-on-Tees TS17 6BH
  2. bUniversity Hospital of North Durham, Durham DH1 5TW
  1. Correspondence to: P J Wright
  • Accepted 15 August 2002

Perhaps surprisingly there are as yet no guidelines for managing acute renal colic in primary care. A group of Durham general practitioners and specialists endeavour to remedy the deficiency

Acute renal colic is a common, often recurrent condition with an annual incidence of 1-2 cases per 1000 and a lifetime risk of 10-20% for men and 3-5% for women.13 Patients usually present with acute pain and pose management challenges for the general practitioner, who may be uncertain whether immediate hospital admission is needed and, if not, how and when patients should be followed up.4 In many patients sent to hospital the pain remits on the way to hospital, or soon after admission, in response to the analgesia given by the general practitioner, making the admission perhaps unnecessary.5 The majority of those calling NHS Direct with acute renal colic are advised to contact their general practitioners “urgently”; a small number are referred to the accident and emergency services; and some are advised how to treat themselves.6

Summary points

There is uncertainty about the immediate management of patients presenting with acute renal colic in primary care, and whether this can be overcome by adopting a pre-established integrated pathway of care across the primary-secondary care interface

Intramuscular diclofenac 75 mg is recommended as first line of treatment when the diagnosis is clear and there are no signs of complications

If the severe pain does not remit within an hour the patient should be admitted to hospital

All patients, whether managed at home or in hospital, should be offered fast track urological investigation with follow up

Opaque radiography and ultrasound are being augmented by the use of spiral computed tomography in some centres in certain situations


We aimed to develop, by evidence based consensus, a management plan for patients with …

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