6 - Urologic Stone Disease

Question 1

Inhibitory substances such _________ can prevent crystal precipitation and stone formation

Answer 1

Citrate

Magnesium

Question 2

Struvite stones are associated with:

Answer 2

Urea-splitting bacteria

• proteus
• klebsiella
• staph aureus
• providencia
• corynebacterium

Question 3

MCC of staghorn calculi?

Answer 3

Struvite stones

Question 4

What are staghorn calculi

Answer 4

Large stones that form a cast in the renal pelvis

Question 5

Does ABX work for staghorn?

Answer 5

No, shitty penetration

Its a massive stone filling in the renal pelvis / calyx thing

Question 6

Risk factors for kidney stones:

Answer 6

Slide 8

Question 7

Pain for stones due to

Answer 7

Obstruction of the Hollow viscous organ (ureter) and subsequent hydronephrosis creating pressure against Gerota’s fascia, causing flank pain

Question 8

Isolated small renal pelvis stones (not staghorn). - pain?

Answer 8

No, not unless they cause intermittent obstructiobn

Question 9

Why no serum create rise in acute obstruction?

Answer 9

Kidney’s are amazing and can operate 185% of baseline

If serum creat is high, suggests solitary kidney or pre-existing renal dz

Question 10

Where does the stone get caught?

Answer 10

1. UPJ (uretopelvic junction)
2. Pelvic brim
3. UVJ (ureteroviscal junction)

Question 11

98% of stones less than 5mm

Answer 11

Will pass within 4 weeks without intervention

Question 12

Stone greater than 7mm?

Answer 12

Have the urologist come down to the ED

Question 13

Stone between 5 and 7mm

Answer 13

Can be seen outpatient

Question 14

Less than 5mm?

Answer 14

Outpatient, PCM

Question 15

Big reason to admit?

Answer 15

Pain

They’ve still got a good kidney, they’re just being admitted for pain control

Question 16

Is hematuria required for the dx of stones?

Answer 16

No, but along with other sxs, it provides a high index of suspicion

Question 17

Two mimickers for stones you must exclude:

Answer 17

AAA

Renal artery infarction

Question 18

MC misdiagnosis given to patients with a rupturing or expanding AAA?

Answer 18

Nephrolithiasis

Question 19

Stones don’t usually present in:

Answer 19

Dudes over 60

Stones also don’t cause HOTN, even transiently

Question 20

Risk factors for poor outcomes

Answer 20

Slide 15

Question 21

Female with suspected kidney stone?

Answer 21

Don’t forget to r/o pregnancy / possible ectopic

Question 22

Check the urine for

Answer 22

Blood

Infection

Question 23

All kids with stone

Answer 23

Send culture

Question 24

CT for stones?

Answer 24

CT without contrast - study of choice

If we use contrast, can’t see the stone

Question 25

Plain films?

Answer 25

90% of stones are radiopaque

Question 26

Ultrasound for stones?

Answer 26

Not great - easy to miss stones under 5mm

But you can see bigger ones, or maybe discover another problem

Question 27

Txt for stones

Answer 27

Pain control
Nausea control
ABX if signs of infection
Medical expulsion therapy (NSAIDs, alpha blockers)

IV fluids make no difference - just drink water if you’re not throwing up

Question 28

Primary choice of analgesics for stones?

Answer 28

NSAIDs

Question 29

Who shouldn’t get NSAIDs

Answer 29

ASA or NSAID sensitivity
Coagulopathy
GI bleeding risk
Renal impairment

Question 30

Pt with a stone and signs of pyelo?

Answer 30

IV ABX and admit

Question 31

Steroids for stones?

Answer 31

No

Question 32

Slide 35

Answer 32

Indications for admission

Most of it pretty obvious

Question 33

Pt has stones and only one kidney?

Answer 33

Auto-admission

Question 34

Pts with hematuria, (-) imaging studies, and no other source require:

Answer 34

Outpatient urologic follow-up

Question 35

Up to 30% of children with stones have:

Answer 35

Urinary tract anomalies

Question 36

When you get a bladder stone?

Answer 36

Urine trouble!!!