What should be included in management for a patient with small asymptomatic renal stones?

For a patient with small asymptomatic renal stones, observation and hydration is the appropriate management strategy. Small renal stones, typically those less than 5 mm in diameter, often do not cause any symptoms and have a high likelihood of passing spontaneously without any intervention.

Hydration is crucial as it helps to facilitate the passage of these stones through the urinary tract. Maintaining adequate fluid intake can dilute the urine and promote the movement of the stone, minimizing the risk of complications like obstruction or infection.

Immediate surgery is reserved for patients with symptoms, complications, or larger stones that are unlikely to pass on their own. Aggressive diuretics are not indicated in this context, as they do not assist in the management of small stones and could potentially lead to dehydration. Daily pain medication may be necessary if the stones cause pain, but for asymptomatic stones, this is not warranted. Observational management with hydration is the safe and effective approach.