Kidney Stones

Question 1

Symptoms of Kidney stones

Answer 1

Renal colic= loin to groin pain
Nausea and vomiting
Haematuria
UTI
Obstruction/Anuria

Question 2

Types of Stones

Answer 2

Calcium oxalate
Urate
Struvite - staghorn
cysteine

Question 3

Investigations

Answer 3

Bloods - FBC (Infection), U+Es(kidney dysfunction), Calcium/phosphate, Glucose, Bicarbonate, Urate

Urine dipstick

Question 4

Imaging for renal stones

Answer 4

Renal USS
Non Contrast CT KUB/plain film KUB
IV urogram visualises obstruction

Question 5

Conservative treatment

Answer 5

Analgesia = Diclofenac or morphine
IV fluids
ABX - gentamicin

Question 6

Medical treatment

Answer 6

Small stones pass spontaneously,

If not passing - nifedipine or tamsulosine(alpha blockers) stimulate smooth muscle.

Question 7

Surgical treatment

Answer 7

Flexible cystoscopy, Shock wave lithotripsy

For large stones percutaneous nephrolithotomy.

Question 8

Complications

Answer 8

Hydronephrosis requiring nephrostomy or stenting of ureters.
Pyelonephritis

Question 9

Prevention of stones

Answer 9

Drink large volumes of water.
Diuretics used decreasing Ca excretion
Avoiding oxalate(chocolate/tea/spinach/
Treat UTI (proteus infection causes struvite)
Allopurinol for gout treatment stops urate stone formation.

Question 10

Causes of Kidney Stones

Answer 10

Poor hydration at work
High oxalate intake - chocolate/tea/spinach
Diuretics, steroids, aspirin etc.

Family history, GU abnormalities, history of UTI, Stents and catheters.

Question 11

Metabolic causes of renal stones

Answer 11

hypercalcaemia/hyperoxalaemia/
hyperparathyroidism
hyperthryroidism, 
Cysteinuria. 
Renal tubular acidosis