Case-Kidney stone Flashcards
Management for Kindey stone
Pain control
HYDRATION
What is 1st line pain control?
NSAIDS (Toradol= Ketorlac)
When would we give opioids?
-Don’t respond to NSAIDs
-Intolerant of NSAIDs (contraindications)
-Severe renal disease
“DIS”
Stone passage:
≤__mm usually pass spontaneously
5
Stone Passage:
≥__ mm, probably won’t pass spontaneously
10
Stone size range when we use medical expulsion therapy
5-10mm
1st line medical expulsion therapy?
How long?
Tamsulosin (Flomax) alpha 1 blocker
up to 4wks
Other options for medical expulsion therapy?
CCB (nifedipine) non-dipines
Tadalafil (PDE5 inhibitor)
= vasodilators
“CT
Indications for inpatient admission for kidney stone
- Fever
- Uncontrollable pain
- NPO= Inability to tolerate PO
“Kidney stones are no FUN”
Indications for Urology consult in admitted kidney stone
- Pain (unyielding)
- Anuria
- Stone present >4wks
- Concurrent UTI
- AKI
- N/V (unyielding)
“PA SCAN”
Supportive measures for admitted kidney stone
- Treat Sx
- Obs
- Alpha blocker (if stone b/w 5-10mm)
- Strain urine
“TOASt”
T/F? Patients should strain their urine and bring in any stone that passes for analysis
True
MC type of stone
Calcium Oxalate
Struvite Stones only form in the presence of _____ producing ______
Urease, Bacteria = - Proteus mirabili - Ureaplasma urealyticum - Corynebacterium species - Klebsiella pneumoniae
What imaging modality is 1st line?
CT A/P w/o
- Can see hydronephrosis
- HIGHEST accuracy for NEPHROLITHIASIS
What can you see on UA?
Hematuria
T/F? You cannot see hydronephrosis on KUB U/S
False
Other types of stones?
- Calcium Phosphate
- Uric acid
- Struvite
What can you see on PE for nephrolithiasis?
CVA tenderness
T/F? BUN:Cr ↑ for nephrolithiasis
True, but not aggressively
T/F? Stone recurrence is probable after 1st episode?
True
When to perform
Surgery?
Stones >12mm
What kind of surgery is performed to remove stones?
Lithotripsy
T/F: Ultrasound of kidneys and bladder can show hydronephrosis
True
T/F: 1st line imaging for kindey stone is u/s of kidneys & bladder
False. U/S is 2nd line
CT A/P w/o contrast is 1st line
Do we order a CT A/P with or w/o contrast 1st line?
CT A/P without contrast
