CHOC Children’s Pediatric Urology Stones Algorithm

Signs and symptoms of urinary stones

Heath History/Physical Examination / Urine culture / Imaging (Ultrasound + (KUB) Kidney, Ureter, Bladder X-ray)

Stone Stone No Stone

Passed Identified Identified

Stone Stone  < 4mm  > 4mm High index of

Recovered Not Recovered Positive family
 Asymptomatic  Refractory symptoms suspicion – consider
history -
 Non-obstructing  Solitary kidney noncontrast CT
Metabolic
 Obstructing (Kidney, Urinary,
Stone analysis evaluation
 Fever >38° c / 100.4° f Bladder)

Calcium Stone
Uric acid/CaPO4/Cystine/Struvite Urologic/surgical Normal
oxalate ruled out
consultation (consider
(consider Abnormal
alternative
alternative
diagnosis)
diagnosis)
Complete
Complete metabolic evaluation*(see below) with
metabolic
concomitant directed therapies
workup
4-6 mm –
> 6mm –
follow with 24-hour urine
Consider
ultrasound VS collection and
surgical
surgical regular follow-up
treatment
High urine Normal treatment
oxalate urine oxalate

*Complete metabolic evaluation:

Serum creatinine, Na, K, CI, TCO2 or bicarbonate, calcium & albumin or ionized calcium, uric acid, PO4, Mg
Urine oxalate PH1/PH2 Spot urine: osmolality, creatinine, oxalate, uric acid, sodium, citrate, metabolic screen
metabolites Genetic testing (nitroprusside/DNPH/amino acids) positive screen/abn spot: timed urine
Plasma oxalate Specific RX Hypercalciuria – check for tubular proteinuria (eg B2 microglobulin or amino acids)
Follow up
Ultrasound at discretion of attending physician based on signs and symptoms