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Urology > 1: Renal Stones > Flashcards

1: Renal Stones Flashcards

1
Q

What age is the peak incidence of renal stones

A

20-40 year-olds

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2
Q

What are the 5 types of renal stones

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Struvite
  4. Uric acid
  5. Cystine
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3
Q

What are risk factors for calcium oxalate stones

A

High-calcium
Low urine pH

High oxalate
Low citric acid

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4
Q

What pH of urine increases risk of calcium oxalate stones

A

Low urine pH (acidic)

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5
Q

What type of renal stones is hypercalcaemia most associated with

A

Calcium oxalate

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6
Q

What causes calcium phosphate stones

A

High calcium

Renal tubular acidosis (Type I)

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7
Q

What are risk factors for uric acid stones

A

High uric acid - such as in gout

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8
Q

What cause struvite stones

A

Urease producing bacteria

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9
Q

What are two urease producing bacteria

A
  • Klebsiella pseudomonas

- Proteus mirabilis

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10
Q

What is a RF for cystine stones

A

Cystinuria

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11
Q

What is protective against renal stones

A

Thiazide diuretics - as they increase calcium re-absorption

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12
Q

What are symptoms of renal stones

A
  • Colicky loin to groin pain
  • Patient is unable to lie still
  • Nausea and Vomiting
  • Tenderness over costa-vertebral angle
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13
Q

What 3 medications increase risk of calcium oxalate or calcium phosphate stones

A
  • Acetazolamide
  • Loop diuretics
  • Topiramate
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14
Q

What are the 3 most common sites for stones to become lodged

A
  • Pelvic-ureteric junction
  • Narrowing ureter
  • Vesico-ureteric junction
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15
Q

What is the most common site for stones to be lodged

A

Vesico-ureteric junction

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16
Q

What is the most common type of renal stone

A

Calcium oxalate (85%)

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17
Q

What % of renal stones are calcium oxalate

A

85%

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18
Q

How do calcium oxalate stones present on x-ray

A

Radio-opaque = can be seen on x-ray

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19
Q

What % of stones are uric acid stones

A

10%

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20
Q

How do uric acid stones present on x-ray

A

Radiolucent

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21
Q

What % of stones are cystine stones

A

1%

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22
Q

What causes cystine stones

A

Inherited disorder of metabolism presenting reabsorption of cystine from gut or GI tract

23
Q

What are struvate stones made of

A

Ammonium, magnesium, phosphate

24
Q

What % of stones are struvite

25
How do struvite stones present on x-ray
staghoon calculi - radio-opaque
26
What causes struvite stones
urease producing bacteria
27
What % of stones are calcium phosphate
10%
28
How do calcium phosphate stones appear on x-ray
radio-opaque
29
What are the only stones to be radio-lucent
uric acid stones
30
What is gold-standard investigation for renal stones
CT KUB
31
When should CT KUB be offered
Within 24-hours
32
If poor renal function or pregnant, what is the alternative to CT KUB
- USS
33
what other investigations are ordered in renal stones
- Urinalysis: determine pH (for struvite stones) - FBC (Infection) - U+E (Renal Function) - Bone Profile (Calcium)
34
what is first line management for renal stones
KT KUB
35
what analgesia is offered
IV Diclofenac
36
what does diclofenac increase risk of
Cardiac events
37
aside from analgesia, what else is important when managing renal stones
IV Fluids
38
when are antibiotics offered in renal stones
Tazosin
39
what antibiotics are offered for renal stones
Tazosin (piperaceillin and tazobactum)
40
what % of stones less than 5mm pass spontaneously
90
41
what does surgical management of renal stones depend on
Size of the stone
42
how is a renal stone under 10mm managed first-line
medical exclusion | a-blocker
43
what is used to medically expel small renal stones
a-blocker (tamsulosin)
44
if medical expulsion fails what is used
shockwave lithotripsy
45
what is used to expel stones 10-20mm
ureteroscopy
46
how are renal stones >20mm removed
percutaneous nephrolithotomy (PCNL)
47
if there is evidence of infection what is required
Percutaneous nephrostomy or ureteric stent to relieve obstruction
48
what may be used to aid management of calcium oxalate stones
thiazide diuretics
49
what is specific to management of struvite stones
treat infection
50
how are uric acid stones managed
colchicine, alkalise urine
51
what is used to alkalise the urine
potassium citrate | sodium bicarbonate
52
what can be used to manage cystine stones
penicillamine
53
what can renal stones cause
- UTI, may cause pyelonephritis - Obstruction can lead to hydronephrosis - Bilateral = AKI

Urology (14 decks)

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