For GPs & referrers

Practical information for general practitioners and referring specialists managing patients with kidney and ureteric stone disease.

Send a referral

Referrals can be sent by secure messaging, email or fax. All stone referrals are triaged on the day they arrive - urgent obstructed or infected stones are expedited.

Phone 02 8382 6980
Email Raji.Kooner@svha.org.au
Fax 02 8382 6991
Secure messaging Provider (HealthLink / Argus / Medical Objects) to be confirmed
Call the rooms Email referral

When to phone, when to refer to ED

Kidney stones span a wide clinical spectrum. The key decision in the community is to separate stable renal colic (which can be managed via outpatient referral) from obstructed or infected stones (which need urgent drainage).

Send to ED immediately: any stone patient with fever, rigors, sepsis, uncontrolled pain despite opioids, rising creatinine, a solitary kidney with obstruction, or vomiting preventing oral intake. An obstructed infected system is a urological emergency requiring drainage within hours.

Urgent outpatient referrals

Please phone the rooms for any of the following - these are prioritised ahead of routine:

  • Obstructing stone on imaging with pain, but no fever (likely needs intervention within 1-2 weeks).
  • Patient with an indwelling ureteric stent awaiting definitive treatment.
  • Recurrent stone former with a new obstructing stone or new hydronephrosis.
  • Solitary kidney, transplant kidney, or single functioning kidney with any new stone.
  • Pregnant patient with suspected stone disease (shared care with obstetrics).

What imaging to order

  • First-line: CT KUB (non-contrast, low-dose stone protocol). Reports stone location, size, and Hounsfield density.
  • Pregnancy / paediatrics: renal tract ultrasound first; consider MR urography if diagnosis unclear.
  • Recurrent formers: consider a plain KUB film if the stone is known to be radio-opaque, for simple monitoring.
  • An existing CT from the past 6 months is usually sufficient - repeat imaging is not required before referral in most cases.

Baseline bloods & urine

  • Urinalysis and MSU culture (essential if intervention is planned).
  • FBC, UEC, CMP (calcium), uric acid.
  • For recurrent or young stone formers: PTH, 25-hydroxy vitamin D.
  • A 24-hour urine collection is not required pre-referral - this is organised through the metabolic pathway after assessment.

What to include in your referral letter

  • Clinical question and urgency flag.
  • Stone location, size and laterality from imaging.
  • Current pain status and analgesic requirement.
  • Whether the patient is systemically unwell / febrile.
  • Anticoagulants, anti-platelets, and relevant comorbidities.
  • Any known previous stone episodes, operations or stent history.
  • Patient contact details and preferred consulting location.

Template referral prompts

Short prompts for common stone scenarios:

First presentation with renal colic

"Dear Dr Kooner, please see this [age][sex] patient with first-episode renal colic. CT KUB [date]: [x]mm stone in [proximal/mid/distal] [left/right] ureter, [with/without] hydronephrosis. Pain now [controlled/uncontrolled]. Urine culture: [negative / organism]. Creatinine: [value]. Analgesia: [current regimen]. No fever. For stone management."

Incidentally found kidney stone

"Please see this [age][sex] patient with an incidental [x]mm [non-obstructing] stone in the [upper/mid/lower] pole of the [left/right] kidney on CT [date] done for unrelated reasons. Asymptomatic. eGFR [value]. For opinion on observation vs elective treatment."

Recurrent stone former

"Please review this [age][sex] patient with recurrent kidney stones (last episode [date], previous [interventions]). New [x]mm stone on CT [date], [location]. Family history: [yes/no]. For definitive management and metabolic workup."

Indwelling ureteric stent awaiting treatment

"[Age][sex] patient with [left/right] ureteric stent inserted on [date] at [hospital] for obstructing [x]mm stone. Not yet reviewed for definitive treatment. Please expedite - stent change due [date]."

Suspected stone in pregnancy

"Please review this pregnant patient (gestation [weeks]) with flank pain. Renal USS [date]: [findings]. Afebrile. Urine: [result]. Obstetric team aware. For shared-care opinion."

Turnaround & communication

  • Stone referrals are triaged the same working day.
  • Urgent referrals are usually offered an appointment within 7-10 days.
  • Routine referrals are usually offered an appointment within 2-3 weeks.
  • A detailed consultation letter is sent to the referring GP after each appointment.
  • Dr Kooner is happy to be phoned directly for brief clinical discussion of an urgent case.

Linked stone pages

Kidney stones overviewBackground for patients. Emergency signsWhen stones need ED. Diagnosis & imagingCT KUB and workup. Treatment optionsHow treatment is chosen.

Speak with Dr Kooner's rooms

Arrange a consultation or request a second opinion on an acute stone, a recurrent stone problem, or a recommended procedure.

02 8382 6980 Contact the Clinic