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In my setting, a work-up would include a history, physical, and usually a UA.
Additional work-up which I do on selected patients may include components of the following: a bedside renal and aorta ultrasound, blood testing, possibly a CT, and occasionally a KUB XR.
I'm not skirting the issue at all – you asked me how I would approach a given case and I told you. If a person with a history of uncomplicated renal stone comes into the ED with another presentation and UA consistent with a renal stone, I would presumptively treat them as a kidney stone and might do no testing other than a UA.
I generally opt to do some type of imaging for first time renal stones, as well as patients with history of complicated stones. UA's can be quite difficult to interpret, and Tis established that the presence of a kidney stone can cause leukocytes to be present in the urine, which do not equal an infection. Sometimes additional testing (blood testing, imaging, cultures, etc.) is necessary to determine whether an infection is present. Stable patients with small stones and a UTI would typically be discussed with our urologist on call, who may arrange follow-up, and they would be given a trial of outpatient therapy with return precautions for the ED.
I CT a lot of kidney stones, but I will add this article to the discussion:
http://www.nejm.org/doi/full/10.1056/NEJMoa1404446
For the residents too timid to get in the middle of an "attending brawl", I just put this out there - if I didn't know, what you wrote would confuse me. For me, it is straightforward - if the pt looks like a stone, UA, IV, 1mg Dilaudid, 4mg Zofran, 30mg Toradol, CT-A/P non-con (stone protocol - thinner slices), done. CT negative? Door (because people trying to screw me for drugs are sometimes GREAT actors, as they should be). I get to tell them about "epiploic appendicits" as a possibility. Look ill, too? (Like, febrile, look sick?) CBC, BMP (for the creatinine).
As a note to med students and residents, in the community, you will not gain the enmity of the nursing staff if you bundle your orders. Want to get on the bad side? Piecemeal your labs one at a time. Academics can do that, because no one expects efficiency in that realm. However, in my career, I have had one patient with whom I had an actual good discussion about the pluses and minuses of a CT, and the pt opted for it - for he was an interventional cardiologist, and he got complete relief from 30mg Toradol.
Likewise, a 20-something female with history of stones? Treated symptomatically (including pain meds), and explaining how I wanted to save her the radiation - mother complained that "she always gets an MRI" (yes, she wrote that). That's what happens. Can't win.