Diagnosis of renal colic established by CT,  IVP,  ultrasound, or classic history

 Uncomplicated urinary anatomy (No single or transplanted kidney)

 Persistent pain or vomiting despite medication.

In provider judgement, low likelihood (<50% chance) of needing surgery

Any concern for concurrent urine infection

Unstable vital sigs

 History of solitary kidney

 History of kidney transplant

 Acute renal failure ( > 50% increase in baseline Creatinine or Cr > 3)

 Urology service has evaluated patient in ED and determined patient likely to require surgical intervention or extended medical therapy.

Acceptable VS

Pain and nausea resolved or controlled

Discharge home with urology referral

Persistent vomiting or uncontrolled pain

 Diagnosis of coexistent infection or significant abnormality

 Change in diagnosis requiring further therapy or workup

 Urology intervention required