Quality standard

Quality statement 4: Metabolic testing

Quality statement 4: Metabolic testing

Quality statement

Adults with renal or ureteric stones have their serum calcium measured.

Rationale

Testing serum calcium is a simple way of identifying underlying hypercalcaemic conditions, such as primary hyperparathyroidism or sarcoidosis, that can be treated to prevent recurrence of renal or ureteric stones.

Quality measures

Structure

Evidence of written clinical protocols to ensure that adults with renal or ureteric stones have their serum calcium measured.

Data source: Local data collection, for example, service protocols.

Process

Proportion of adults with a new diagnosis of renal or ureteric stones who have their serum calcium measured.

Numerator – the number in the denominator who have their serum calcium measured.

Denominator – the number of adults with a new diagnosis of renal or ureteric stones.

Data source: Local data collection, for example, local audit of patient records.

Outcome

Diagnosis rates of hypercalcaemic conditions.

Data source: Local data collection, for example, local audit of patient records.

What the quality statement means for different audiences

Service providers (such as GP practices and secondary care services) ensure that systems are in place for adults with renal or ureteric stones to have their serum calcium measured on presentation or at a follow‑up appointment and the test results acted on.

Healthcare professionals (such as GPs, nephrologists, urologists and emergency department practitioners) arrange for adults with renal or ureteric stones to have their serum calcium measured on presentation or at a follow‑up appointment. For adults with recurring stones, healthcare professionals should use clinical judgement to decide whether to measure serum calcium again if it was measured recently. If tests identify an underlying condition, healthcare professionals should discuss treatment options with the person.

Commissioners (such as clinical commissioning groups and NHS England) ensure that services have systems in place to measure serum calcium for adults with renal or ureteric stones on presentation or at a follow‑up appointment and act on the results.

Adults with a stone in their kidney or ureter have blood tests to check if there is anything that could have caused the stone. If a condition is identified, they discuss treatment options with the doctor.

Equality and diversity considerations

All children and young people should have a metabolic assessment, but the nature of the assessment may vary. Referral to a paediatric nephrologist or urologist with expertise in testing for metabolic conditions should be considered. See recommendation 1.7.3 and evidence review A in NICE's guideline on renal and ureteric stones.