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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

A

20%

25
Q

How do struvite stones present on x-ray

A

staghoon calculi - radio-opaque

26
Q

What causes struvite stones

A

urease producing bacteria

27
Q

What % of stones are calcium phosphate

A

10%

28
Q

How do calcium phosphate stones appear on x-ray

A

radio-opaque

29
Q

What are the only stones to be radio-lucent

A

uric acid stones

30
Q

What is gold-standard investigation for renal stones

A

CT KUB

31
Q

When should CT KUB be offered

A

Within 24-hours

32
Q

If poor renal function or pregnant, what is the alternative to CT KUB

A
  • USS
33
Q

what other investigations are ordered in renal stones

A
  • Urinalysis: determine pH (for struvite stones)
  • FBC (Infection)
  • U+E (Renal Function)
  • Bone Profile (Calcium)
34
Q

what is first line management for renal stones

A

KT KUB

35
Q

what analgesia is offered

A

IV Diclofenac

36
Q

what does diclofenac increase risk of

A

Cardiac events

37
Q

aside from analgesia, what else is important when managing renal stones

A

IV Fluids

38
Q

when are antibiotics offered in renal stones

A

Tazosin

39
Q

what antibiotics are offered for renal stones

A

Tazosin (piperaceillin and tazobactum)

40
Q

what % of stones less than 5mm pass spontaneously

A

90

41
Q

what does surgical management of renal stones depend on

A

Size of the stone

42
Q

how is a renal stone under 10mm managed first-line

A

medical exclusion

a-blocker

43
Q

what is used to medically expel small renal stones

A

a-blocker (tamsulosin)

44
Q

if medical expulsion fails what is used

A

shockwave lithotripsy

45
Q

what is used to expel stones 10-20mm

A

ureteroscopy

46
Q

how are renal stones >20mm removed

A

percutaneous nephrolithotomy (PCNL)

47
Q

if there is evidence of infection what is required

A

Percutaneous nephrostomy or ureteric stent to relieve obstruction

48
Q

what may be used to aid management of calcium oxalate stones

A

thiazide diuretics

49
Q

what is specific to management of struvite stones

A

treat infection

50
Q

how are uric acid stones managed

A

colchicine, alkalise urine

51
Q

what is used to alkalise the urine

A

potassium citrate

sodium bicarbonate

52
Q

what can be used to manage cystine stones

A

penicillamine

53
Q

what can renal stones cause

A
  • UTI, may cause pyelonephritis
  • Obstruction can lead to hydronephrosis
  • Bilateral = AKI

Urology (14 decks)

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