kidney stones

Question 1

aka

Answer 1

renal calculi
nephrolithiasis
urolithiasis

Question 2

what are they

Answer 2

hard stones that form in renal pelvis before travelling down ureters

Question 3

most common place from them to get stuck

Answer 3

vesico-ureteric junction

Question 4

two key complications

Answer 4

obstruction

infection

Question 5

most common type of stone

Answer 5

calcium based stones

• calcium oxalate
• calcium phosphate

Question 6

most common stone

Answer 6

calcium oxalate

Question 7

uric acid stone

Answer 7

not visible on xray

Question 8

struvite stone

Answer 8

produced by bacteria and so assoc with infection

Question 9

staghorn calculus

Answer 9

stone forms in shape of renal pelvis
may be seen on X-ray

most commonly with struvite stones

Question 10

features

Answer 10

renal colic
haematuria
nausea or vomit
reduced UO

Question 11

risk factors for calcium stones

Answer 11

hypercalcaemia

low urine output

Question 12

renal colic

Answer 12

unilateral loin to groin pain

fluctuating in severity

Question 13

Ix

Answer 13

urine dipstick 
blood tests
abdo X-ray 
CTKUB
USS

Question 14

initial investigation of choice

Answer 14

non contrase CT KUB

Question 15

Mx

Answer 15

NSAIDs for analgesia
antiemetics
antb if infective
watchful waiting 
tamsulosin 
surgical interventions

Question 16

tamsulosin

Answer 16

alpha blocker

can be useful to aid spontaneous passage of stones

Question 17

when is watchful waiting often used

Answer 17

stones <5mm

50-80% chance will pass

Question 18

Extracorporeal shock wave lithotripsy (ESWL)

Answer 18

shock waves generated to stone under x-ray guidance

breaks up stone making easier to pass

Question 19

Ureteroscopy and laser lithotripsy

Answer 19

camera inserted to visualise stone and then targeted by lasers
break stone up

Question 20

Percutaneous nephrolithotomy (PCNL

Answer 20

under GA

removal stone

Question 21

avoiding recurrent stones - lifestyle advise to patients

Answer 21

increase fluid intake 
add fresh lemon juice to water
avoid carbonated drinks 
reduce dietary salt 
maintain normal calcium intake

Question 22

medications that can be used to reduce riks recurrents in calcium oxalate stones with raised urinary calcium

Answer 22

potassium citrate

thiazide diuretics

Question 23

Mx - stone <2cm in aggregate

Answer 23

shockwave lithotripsy

Question 24

Mx - stone <2cm in pregnant female

Answer 24

uteroscopy

Question 25

Mx - complex renal caluli, staghorn calculi

Answer 25

Percutaneous nephrolithotomy

Question 26

Mx - calculi <5mm

Answer 26

expectant management

Question 27

Mx - evidence of infection

Answer 27

surgical emergency - system must be decompressed

nephrostomy, ureteric catheter, ureteric stent