Kidney stones Flashcards
What are renal stones also called?
Renal calculi
Nephro-urolithiasis
What are the 3 sites for kidney stones?
Pelviruretric junction
Pelvic brim
Vesicoureteric junction
What are the 2 key complications of kidney stones?
Obstruction- causes AKI
Infection with obstructive pyelonephritis
What are the types of kidney stones?
Calcium based stones (80%)
- Calcium oxalate (75%)
- Calcium phosphate
Uric acid- not visible on X- ray
Struvite- produced by bacteria
What is an important cause of renal stones?
Hypercalcaemia
What is the presentation of renal stones?
Asymptomatic
Renal colic
Haematuria
Proteinuria
Nausea or vomiting
Reduced urine output- anuria
Symptoms of sepsis
What is renal colic?
Unilateral loin to groin pain that fluctuates in severity as the stone moves and settles
What investigations are undertaken for kidney stones?
Urine dipstick- haematuria, infection
Bloods- infection, serum calcium
Abdominal X ray- calcium stones
CT KUB- initial investigation of choice
Ultrasound KUB
What is the management of kidney stones?
NSAIDs- intramuscular diclofenac or IV paracetamol
Antiemetics e.g. metoclopramide
Antibiotics- infection
Watchful waiting- <5mm may pass without intervention
Alpha blocker e.g. tamsulosin for spontaneous passage of stone
Surgical intervention- >10mm
What are the indications for surgical treatment?
Obstruction
Recurrent frank haematuria
Recurrent pain and infection
Progressive loss of kidney function
What are the options for surgical intervention?
ESWL
Ureteroscopy and laser lithotripsy
PCNL
Open surgery
What is ESWL?
Extracorporeal shock wave lithotripsy
External machine directs shock waves at the stone under x ray guidance
Breaks stone into fragments that can pass
What is ureteroscopy and laser lithotripsy?
Camera used to identify stone
Stone broken up by targeted lasers, so fragments are able to pass
What is PCNL?
Percutaneous nephrolithotomy
Keyhole surgery performed under general anaesthetic
Nephroscope inserted via small incision in the patients back
Stones broken up into smaller pieces and removed
What are general preventative measures?
Drink plenty
Normal dietary Ca2+ intake
Reduce intake of oxalate rich foods
