Kidney Stone
Referral Guide
A practical clinician resource for identifying kidney stone presentations that should not wait for routine outpatient review, organising useful pre-referral information and generating concise referral wording for urological assessment.
Some stone presentations should bypass routine outpatient referral
Acute or significantly unwell patients require appropriate urgent assessment. An infected obstructed urinary system is a urological emergency and should not wait for an elective clinic appointment.
A useful kidney stone referral starts with four questions
Stone size alone does not determine urgency. Infection, obstruction, renal function, symptoms, stone position and the patient's renal reserve can materially change the pathway.
Is the patient clinically safe for outpatient care?
Screen first for infection, severe pain, anuria, deterioration and other acute features.
Where is the stone and is it obstructing?
Location, maximal stone dimension and hydronephrosis are more useful than simply documenting “renal calculus”.
Is renal function or anatomy higher risk?
A solitary kidney, renal transplant, bilateral obstruction or deterioration in renal function should influence urgency.
What are you asking the urologist to assess?
Treatment, persistent obstruction, recurrent symptoms, surveillance or a complex stone burden are useful referral questions.
Build the kidney stone referral
Five short steps generate an urgency prompt, suggested pre-referral checklist, relevant kidney stone resources and copy-ready referral wording.
What is the main kidney stone presentation?
Choose the option that best captures the reason for urological assessment.
Are any concerning acute features present?
Select all that apply. These prompts are intended to prevent an acutely unwell patient being inadvertently directed into an elective outpatient pathway.
What does the current assessment show?
Complete what is known. Unknown values do not prevent the guide from generating referral wording.
What information is already available?
Select what can accompany the referral. Missing investigations should not delay appropriate urgent or time-sensitive referral.
What would you like the referral to request?
This is used to create the final referral wording. The generated text can be edited before being transferred into clinical software.
Kidney stone referral prepared
Why this pathway was highlighted
Useful information before review
Suggested referral wording
Information that makes kidney stone review more efficient
A referral does not need to be delayed until every item is available, but the following information can substantially improve initial assessment and treatment planning.
Core clinical information
- Current symptoms, duration and whether pain is improving, persistent or increasing
- Fever, urinary infection or recent positive urine culture
- Solitary kidney, renal transplant, bilateral disease or chronic kidney disease
- Current renal function and any change from baseline
- Previous stones, previous procedures and recurrent stone history
- Relevant comorbidities, medications, allergies and anticoagulant therapy
Useful investigations
- Non-contrast CT KUB report where appropriate
- Access to CT images where available
- Urine microscopy, culture and sensitivity
- FBC, electrolytes, urea, creatinine and eGFR
- Serum calcium and urate where relevant
- Previous imaging for comparison and previous stone composition if known
Think beyond stone size
The clinical status of the patient and the consequences of obstruction are often more important to referral urgency than the stone diameter in isolation.
Do not wait for routine clinic
Appropriate acute assessment should be considered where the patient is significantly unwell or complications are suspected.
- Suspected infected obstruction / urinary sepsis
- Anuria or significant oliguria
- Severe uncontrolled renal colic
- Significant acute deterioration or inability to maintain hydration
Higher-risk outpatient presentations
Specialist assessment should not be unnecessarily delayed where obstruction or renal reserve is concerning.
- Ureteric stone with deteriorating renal function
- Solitary functioning kidney or renal transplant
- Persistent obstruction or increasing symptoms
- Bilateral obstructing disease
- Large, complex or staghorn stone burden
Routine specialist discussion
Many stable stone presentations can be reviewed electively when there are no concerning acute or renal-risk features.
- Stable symptomatic renal stones
- Recurrent stone episodes
- Asymptomatic stones requiring surveillance discussion
- Residual fragments following previous treatment
- Stone prevention and recurrent-stone assessment
Information to support the referral conversation
These pages can also be sent to patients after the clinical pathway has been established.
Need to refer a kidney stone patient?
A concise referral with the clinical presentation, relevant imaging, renal function and the specific question for urological review is sufficient to begin specialist assessment.
Clinician resource: This guide provides general referral-support prompts for qualified healthcare professionals. It does not replace clinical judgement, local emergency pathways, HealthPathways, Queensland Health referral criteria or formal specialist triage. It does not diagnose a stone, determine suitability for outpatient management or prescribe treatment. Acute severe renal or ureteric colic, suspected infection with obstruction, urinary sepsis, anuria or other concerning deterioration should be managed through an appropriate urgent pathway. Pregnancy, children, transplanted kidneys and other special clinical situations require individual assessment. Treatment recommendations can only be made following appropriate clinical review.