GU Flashcards
what is another name for UTI stones
Urolithiasis, renal calculi, nephrolothoasis
why do stones form
when urine is supersaturated with salt and minerals
what type of minerals form stones
- calcium
- struvite
- uric acid
- cystine
Describe the formation of calcium oxalate stones
Calcium oxalate precipitates form in the basement membrane of the thin loops of Henle; these eventually accumulate in the subepithelial space of the renal papillae, leading to a Randall’s plaque and eventually a calculus
what are the causes of bladder stones
- foreign bodies
- infection
- obstructions
Risk factors for renal stones
- anatomical abnormalities
- gout
- FHx
- HTN
- hyperparathyroidism
- immobilisation
- dehydration
- drugs
- obesity
symptoms of kidney stones
- asymptomatic
- sudden onset severe pain
- Rigors and fever.
- Dysuria.
- Haematuria.
- Urinary retention.
- Nausea and vomiting.
Differential diagnosis of renal colic
- Biliary colic
- Dissected aortic aneurysm
- pyelonephritis
- acute pancreatitis
- acute appendicitis
- perforated peptic ulcer
- Epididymo-orchitis
- drug misuse
Ix for renal colic
- urine dip
- MSU & culture
- FBC
- CRP
- U&E
- Prothrombin time
Where to kidney stones most frequently get stuck
vesico-ureteric junction
what are the two complications of kidney stones
- infection
- obstruction
What are the two types of calcium kidney stones
- calcium oxalate
- calcium phosphate
what is a stag horn calculus
where a stone forms in the shape of the renal pelvis
what type of kidney stone is stag horn calculus more common in
struvite
what is renal colic
- unilateral loin to groin pain that fluctuates in severity = colicky!!
what imaging can be done for kidney stones
- abdo XR
- non-contrast CT
- US kidneys/ureters/bladder
what is a common cause of kidney stones
hypercalaemia
what are the common symptoms of hypercalcaemia
stones, bones, groans and moans
- renal stones
- painful bones
- abdo groans
- psychiatric moans
3 common causes of hypercalcaemia
- calcium supplementation
- hyperparathyroidism
- CA (myoloma/breast/lung)
indications for hospital admission with urolithiasis
- Signs of systemic infection - eg, fever, sweats, sepsis.
- Increased risk of acute kidney injury - eg, solitary kidney, known non-functioning kidney, transplanted kidney, suspected bilateral renal
stones. - Inadequate pain relief or persistent pain.
- Inability to take adequate fluids due to nausea and vomiting.
- Anuria.
- Inability to arrange imaging within 24 hours.
- Diagnostic uncertainty
Initial Mx for urolithiasis
- NSAIDs
- antiemetics or rehydration therapy if needed
what is the first line NSAID in urolithiasis
- diclofenac (IM)
what would you use to Mx urolithiasis if NSAIDs are contraindicated
IV paracetamol
how quickly does imaging need to occur with ?urolithiasis
24hrs
what are the Mx options for urolithiasis
- stones passes by itself with pain management
- surgery
complications of urolithiasis
- decrease in eGFR >48hrs can result in permanent kidney damage
- infection
- ureteric stricture