kidney stones Flashcards
aka
renal calculi
nephrolithiasis
urolithiasis
what are they
hard stones that form in renal pelvis before travelling down ureters
most common place from them to get stuck
vesico-ureteric junction
two key complications
obstruction
infection
most common type of stone
calcium based stones
- calcium oxalate
- calcium phosphate
most common stone
calcium oxalate
uric acid stone
not visible on xray
struvite stone
produced by bacteria and so assoc with infection
staghorn calculus
stone forms in shape of renal pelvis
may be seen on X-ray
most commonly with struvite stones
features
renal colic
haematuria
nausea or vomit
reduced UO
risk factors for calcium stones
hypercalcaemia
low urine output
renal colic
unilateral loin to groin pain
fluctuating in severity
Ix
urine dipstick blood tests abdo X-ray CTKUB USS
initial investigation of choice
non contrase CT KUB
Mx
NSAIDs for analgesia antiemetics antb if infective watchful waiting tamsulosin surgical interventions
tamsulosin
alpha blocker
can be useful to aid spontaneous passage of stones
when is watchful waiting often used
stones <5mm
50-80% chance will pass
Extracorporeal shock wave lithotripsy (ESWL)
shock waves generated to stone under x-ray guidance
breaks up stone making easier to pass
Ureteroscopy and laser lithotripsy
camera inserted to visualise stone and then targeted by lasers
break stone up
Percutaneous nephrolithotomy (PCNL
under GA
removal stone
avoiding recurrent stones - lifestyle advise to patients
increase fluid intake add fresh lemon juice to water avoid carbonated drinks reduce dietary salt maintain normal calcium intake
medications that can be used to reduce riks recurrents in calcium oxalate stones with raised urinary calcium
potassium citrate
thiazide diuretics
Mx - stone <2cm in aggregate
shockwave lithotripsy
Mx - stone <2cm in pregnant female
uteroscopy
