Introduction

The incidence of kidney stones is increasing in all ages across the world and is thought to be related to dietary changes (increased salt and animal protein intake), climate change and increasing general health comorbidities (eg. sedentary lifestyles, obesity, metabolic syndrome).

The acute management of kidney stones is guided by urology. The role of a nephrologist is in stone prevention. We assess for underlying causes or risk factors for stone formation to prevent future episodes and the associated implications for renal health.

Important Note

Ideally patients are seen at their first appointment with a complete set of blood and urine screening tests as prescribed below, allowing for the provision of specific advice. If these tests are not performed, recommendations are generic (effectively to maintain a high fluid intake and low salt diet) and next follow up may not be for many months to discuss pathology results.

When to refer

• Patients <18 years
• All children with nephrolithiasis should be referred

NB: Urology discussion/referral is also indicated in the following situations:

• Symptomatic stones
• Stone complicated by infection and/or AKI
• Stone in single kidney/transplant kidney
• Large stones (>10mm)

Wait time for appointments

Specialist Clinic wait times

(Please note, non-urgent referrals for patients over the age of 16 may be declined if it is likely they will not be seen before their 18^th birthday.)

Services available closer to home

Alternative paediatric nephrology services available in Victoria:

• Monash Children's Hospital

Referral criteria/required information

Starred items (*) are required in all patients.

• *Details of clinical concern requiring nephrologist input, including duration of symptoms and details of all treatments offered or tried (please include if urology have also been consulted)
• *Current height and weight
• *Observations including BP
• *Blood tests:
  • Electrolytes, urea, creatinine (EUC)
  • Calcium, magnesium, phosphate, albumin
  • Uric acid
  • PTH and vitamin D (if hypercalcaemic)
• *Urine tests (these tests are mandatory for all patients – see above):
  • Urinalysis (particularly for pH and specific gravity)
  • Urine microscopy and culture
  • Calcium:creatinine ratio
  • Oxalate:creatinine ratio
  • Citrate:creatinine ratio
  • Urate:creatinine ratio
  • Urine metabolic screen (screen for cystinuria)
  • Magnesium:creatinine ratio
• *Renal ultrasound or other imaging reports
• *Stone analysis/composition report – if stone can be retrieved or caught

Failure to include reports of pathology and radiology investigations will result in the referral being returned to the referring doctor for resubmission.

Referrals from public hospitals MUST INCLUDE the name and contact details of a consultant supervising paediatrician.

How to refer

Specialist Clinics referral

Please complete the above and submit via:

• Facsimile (03) 9345 5034 or
• Email screferrals@rch.org.au
• Emergencies only all emergencies related to kidney stones should be referred to Paediatric Urology via switchboard (03) 9345 5522

Suggested pre-referral management

• Provide red flag advice to seek medical care if symptoms develop (obstruction or UTI).
• Good hydration to ensure dilute urine and a low salt diet are key to management for all cases of nephrolithiasis, irrespective of the stone composition or underlying risk factors.
• Patients with symptomatic stones should be instructed to sieve their urine to retrieve any passed stones, as stone analysis is the most useful test in assessing the underlying cause and prescribing preventative treatment.

Information for families

Your child’s referral will be triaged based on the information received in the referral. Your referrer will continue to monitor and manage your child’s care prior to and after your consultation. If there is a change in the clinical situation, a new referral explaining the need for re-triage of the referral is required. If you are seen elsewhere, please cancel your appointment with our service so that we can provide service to another child on our wait list.

Resources and links

• National Kidney Foundation: Kidney Stones in Children & Teens
• MCH Information Sheet

Acknowledgements

The development of this guideline was coordinated by the Department of Nephrology. Guideline reviewed in June 2026.