kidney stones

Question 1

where is the most common location that stones get stuck

Answer 1

vesico-ureteric junction

Question 2

key complications of renal stones

Answer 2

obstruction
infection

Question 3

most common type of kidney stones

Answer 3

calcium based stones (80%)
- raised serum calcium and low urine output are key risk factors

Question 4

types of calcium stones

Answer 4

calcium oxalate
calcium phosphate

Question 5

presentation of kidney stones

Answer 5

renal colic: unilateral loin to groin pain, colicky pain
haematuria
nausea and vomiting
reduced urine output
symptoms of sepsis

Question 6

investigations for kidney stones

Answer 6

** Non-contrast CT KUB- first line
urine dip shows haematuria (not that helpful except to exclude infection)
blood tests for infection, kidney function and serum calcium
abdo x-ray may show calcium based stones

Question 7

presentation of hypercalcaemia

Answer 7

renal stones, painful bones, abdominal groans and psychiatric moans

Question 8

causes of hypercalcaemia

Answer 8

calcium supplementation
hyperparathyroid
cancer (myeloma, breast or lung)

Question 9

management of kidney stones

Answer 9

NSAIDs most effective analgesia (IM diclofenac), IV paracetamol where NSAIDs not option
antiemetics
antibiotics if infection
watchful wait some stones pass
tamsulosin can help
surgical intervention for larger stones

Question 10

management of kidney stones 5-10mm

Answer 10

shockwave lithotripsy
- not in infection (obstruction must be relieved first)

Question 11

management of 10-20 mm kidney stone

Answer 11

shockwave lithotripsy or ureteroscopy

Question 12

stones >20mm management

Answer 12

percutaneous nephrolithotomy

Question 13

most common composition of stag-horn calculus

Answer 13

struvite
- form alkaline urine