13) Renal stone disease Flashcards
give all the characterisation for calcium oxalate stones ?
how common
etiology
urin ph
crystal appearance
radiopacity
prophylaxis
most commonly occurring
etiology :
associated with hypercalciurea
hyperuxaluria
hypocitraturia - vit C
associated with inflammatory bowel disease such as uc and chrons disease due to malabsorption
URINE ph
tuns the uring ph acidic
Urine microscopy: dumbbell-shaped or octahedron-shaped
CALCIUM OXALATE MONOHYDRATE : brown or black calculi
DIHYDRATE : LIGHT YELLOW
radiopacity
positive
prophylaxis
urine alkalisation
give all the characterisation for uric acid stones ?
etiology
urin ph
crystal appearance
radiopacity
prophylaxis
etiology :Gout, hyperuricemia, and hyperuricosuria
High cell turnover
↓ Urine pH (acidic) and volume
Rounded rhomboids, rosettes, or needle-shaped
Radiolucent
Urine alkalinization
give all the characterisation for struvite stones ?
etiology
urin ph
crystal appearance
radiopacity
prophylaxis
UTI with urease-producing bacteria (e.g., Proteus mirabilis, S. saprophyticus, Klebsiella)
↑ Urine pH (alcalic)
Rectangular prisms (coffin lid-appearance)
Weakly radiopaque
Urine acidification
give all the characterisation for struvite stones ?
etiology
urin ph
crystal appearance
radiopacity
prophylaxis
Calcium phosphate stones
hyperparathyroidism
increase in urine Ph
Wedge-shaped prisms
radiopaque
urine acidification
what is the treatmnet for calcium oxalate stones ?
Hydration
Dietary modification
Reduced intake of salt (mainly sodium) and animal protein
Reduced intake of oxalate-rich foods and supplemental vitamin C
Calcium intake should not be restricted
Thiazide diuretics for recurrent calcium-containing stones with idiopathic hypercalciuria
Urine alkalinization (e.g., with potassium citrate)
allopurinol in case of high uric acid
diagnosis for uric acidd stones ?
CT
US
intravenous pyelogram
what is the treatmnet for uric acid stones
Hydration
urine alkalinization
Low-purine diet
Allopurinol
what is stag horn calculi ?
particularly of Struvite stones
Can form very large stones that fill the entire renal pelvis and calyces
what is the treatmnet for striate calculi ?
Antibiotic treatment of urinary tract infections
Hydration
Urine acidification -
cranberry juice dairy products, grains
Usually require surgical stone removal
what are the clinical manifestations of renal stones ?
Severe unilateral and colicky flank pain
Radiates anteriorly to the lower abdomen, groin, labia, testicles, or perineum
Paroxysmal or progressively worsening
(costovertebral angle tenderness)
gross or micro Hematuria!
vomitting
dysuria
increased frequency and urgency to pee
what are the diagnostic modalities for renal stones ?
===== US
urineph
urine microscopy
urine culture
24 hour urine profile
assess the element
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goden standrad CT - without contrast
can show hydronephrosis
x RAY
WHAT ARE THEMEDICAL THERAPY IN THE CASE FOR all renal stones ?
hydration
analgesia - NSAID o IV mrphine
medical explosive therapy : alpha blockers - tamsulosin
or CCB - nifedipine
- release also ureter muscle spams
promote passage of less than 10 mm
antispasmodics : butylscopolomine
when are non invasive and surgical interventions indicated ?
stones more than 10mm
complicated - sepsis , AKI , intractable pain
failed medical therapy
failure of stone passing after 4 -6 wks
what are the procedures for non invasive techniques in renal store ?
Extracorporeal shock wave lithotripsy
renal and proximal ureteral stones
Stones should be clearly visible on x-ray and/or ultrasound
Contraindicated in cases of untreated UTI, during pregnancy
what are the invasive procedures for stones
Ureterorenoscopy
======
Percutaneous nephrolithotomy
> over 20mm stones
puncture of the renal pelvis calyx under sonographic and radiological guidance → → fragmentation of stones and retrieval of the fragments
=========
Ureteral stenting or percutaneous nephrostomy
Stenting can be performed following endoscopic stone removal and in the case of ureteral injury, evidence of ureteral stricture, or large residual stones.
Nephrostomy can be used for decompression in the case of severely obstructed or infected pyelon
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Pyelolithotomy/ureterolithotomy
very rare
