Renal colic

• Diclofenac (not if eGFR low), Paracetamol IV, Tamsulosin (ureteric stone 5–10 mm), Ondansetron

• Refer the same day: Fever with chills and a blocked kidney (needs drainage), single kidney, no urine, persistent blood in urine, or pain not controlled; drink over 2 L/day, do not cut calcium (EAU 2026; ICMR STW 2025)

First visit

• Urine routine — Blood in urine; infection.
• Serum creatinine — Before NSAIDs and contrast.
• USG KUB — First imaging; safe in pregnancy and children.

Only if indicated

• Non-contrast CT KUB — Uncertain diagnosis or planning treatment (most accurate).
• CBC, urine culture — Fever (an infected blocked kidney needs urgent drainage).
• Serum calcium, uric acid — Recurrent stones.

Follow-up and monitoring

• Repeat USG or X-ray KUB — In 2–4 weeks on medical expulsive therapy.