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Renal / Urology > Kidney Stones > Flashcards

Kidney Stones Flashcards

1
Q

What is the real name for kidney stones

A

Nephrotic-urolithiasis

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2
Q

What is a colic

A

Acute severe loin pain most commonly caused by an obstruction usually kidney stone
Due to peristalsis trying to push stone through

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3
Q

When is urgent intervention needed

A 
Infection
Obstruction
Impending AKI
Previous transplant
Abnormality
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4
Q

What do you do as urgent intervention

A

ABCDE
Sepsis 6
Percutaneous nephrostomy or ureteric stent

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5
Q

What are different stone types

A 
Calcium oxalate = 75% 
Calcium oxalate + phosphate
Calcium phosphate
Triple phosphate (infective) 
Uric acid 
Cysteine
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6
Q

What is most common type of stone

A

Calcium oxalate

- Radio-opaque

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7
Q

What can phosphate cause

A

Renal tubular acidosis

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8
Q

What causes uric acid stones

A 
Metabolic disorder
Children
Tissue breakdown
Malignancy 
Low pH as breakdown purine
Gout
Ileostomy (loss bicarb)
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9
Q

Will you see uric acid / xanthine stones on Xray

A

No

Radio-lucent so let X-ray pass to appear black

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10
Q

What causes cysteine stones

A

AR disorder of cysteine

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11
Q

What causes stag horn calculi and what type of urine

A

Proteus infection
Magnesium ammonium phosphate stones - Sturvie
Alkali urine

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12
Q

Where do stones present

A

VUJ
PUJ
Pelvic brim
Narrowest areas

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13
Q

How do renal stones present

A 
Renal pain - colic 
Ureteric colic - radiates to groin
As peristalsis pushes stone down urethra 
Restless
N+V
Dysuria
Haematuria
Proteinuria
Sterile pyuria 
UTI
Oliguria
FUNI Sx
- Frequency and urgency = most common 
- Nocturia / incontinence = less common
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14
Q

What suggests secondary infection and urgent RX

A

Pyrexia
Loin tenderness
Pyuria

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15
Q

What must you exclude

A 
RUPTURED AAA
Pulsatile mass
Pulses
BP mismatch 
CT
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16
Q

What are RF for developing stones

A 
Recurrent UTI 
Metabolic - hyper Ca, uric, PTH 
Urinary tract abnormality - PKD / horse shoe kidney 
Foreign body
Dehydration
High protein diet
Renal tubular acidosis
Drugs 
FH
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17
Q

What drugs

A

Loop diuretic
Steroid
Theophylline

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18
Q

How do you Dx renal stone

A

USS often used as quick initial test but may miss small
Non contrast CT KUB = 1st line
X-Ray KUB or IVU = less sensitive

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19
Q

When do you do non-contrast CT KUB

A

Immediate if fever or 1 kidney or if uncertain over AAA

Within 14 hours otherwise

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20
Q

What other investigations do you do

A

Bloods - for infection and renal function
Split renal function
Urine Dipstick - blood, exclude infection / UTI
bhCG in all women with abdominal pain
MSSU
Blood culture of other septic signs

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21
Q

What bloods

A 
FBC - infection 
U+E - renal function 
CRP - infection 
Coag if intervention
Calcium / albumin / urate / bicarb / glucose / PTH for underlying cause
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22
Q

If CT shows hydronephrosis what does this suggest

A

Stone is obstructing so urgent Rx needed

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23
Q

What is analgesia of choice

A

NSAID
IM diclofenac as severe pain
Beware of CVS risk

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24
Q

When do you admit

A 
If require IV analgesia
Deranged U+E
Hydronephrosis 
Complications 
Signs of infection - hypo / fever / tachy / raised WCC 
Surgical Rx required
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25
Q

What are general measures with kidney stones

A

Analgesia
Anti-emetic
IV fluid
Ax if infection

Can send home with medical if small stone, no pain and no complications
Nifedipine - CCB
Tamsulosin (a-blocker)

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26
Q

What does nifedipine do

A

Start expulsion

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27
Q

What do you do if stone <5mm

A

Should pass with fluid with 24 hours

28
Q

What do you prescribe as analgesia

A

Morphine
Diclofenac
Anti-emetic (Cyclisine)

29
Q

What does Rx depend on

A

Size
Site
Co-morbid
Renal function

30
Q

What is 1st line

A

ESWL

Day Rx and non-invasive

31
Q

When is ESWL CI

A 
>2cm
High BP
Anti-coagulant
Pregnancy
Infection
AAA
32
Q

When would you do PCNL - percutaneous through back

A 
Large stone
PUJ stenosis
Stricture
MOrbid obese
UTI
Coagulopathy
Fibrosis 
Small kidney
High BP 
Pregnancy 
Staghorn
EWSL resistant
33
Q

When would you do utereoscopy + laser

A

<2cm but ESWL CI i.e. pregnancy

34
Q

When would you do nephrectomy

A

Non-functioning infected kidney
Large stones
URGENT

35
Q

What are indications for surgery

A 
Obstruction
Impending AKI
Recurrent haematuria
Recurrent pain and infection
Loss of kidney function
Occupation
36
Q

What are complications of PCNL

A 
Pseudoaneurysm
AV fistula 
Ureteric injury
Bowel injury
Pneumothorax
Sepsis
MI
37
Q

How do you prevent formation of calcium stones

A

Thiazide diuretic > loop to decrease Ca

High fluid

38
Q

How do you prevent oxalate stones

A

CHolestyamine

39
Q

How do you prevent uric acid stones

A

Allopurinol

Oral bicarb

40
Q

What is the DDX of renal stone

A 
Triple A
Pyelonephritis
Obstruction
Malignncy
Bowel 
Trauma - ureteric rupture
41
Q

What makes pyelonephritis more likely

A

Septic

Urinary signs

42
Q

Malignancy

A

More chronic

43
Q

Ureteric rupture

A

Iatrogenic e.g. pelvic fracture

44
Q

How do ureteric stones present

A

Bladder irritability
Pain in scrotum / penis / labia
Mimic appendicitis / diverticulitis

45
Q

How do you Dx

A

CT = 1st line

IVU

46
Q

How do you treat

A

ESWL 1st line

Uretereoscopy

47
Q

When is ureteroscopy indicated

A 
Obstruction 
Pain 
Fever 
Persistent haematuria
Failed ESWL
48
Q

Complications of ureteric stone

A

Infection

49
Q

Complications of ureteroscopy

A 
Perforation
Haematuria
Minor VUJ reflux 
Fever
Uretral necrosis / stricture
50
Q

What causes bladder stones

A

Usually 2 to bladder outflow obstruction

51
Q

What are the symptoms of bladder stones

A 
Suprapubic / groin pain
Dysuria
Strangury 
Frequency
Haematuria
UTI 
Sudden interruption of stream
52
Q

How do you treat bladder stone

A

Cystolithoplaxy (endoscopic excision)

Surgery if large

53
Q

When can you not do op

A

Septic

54
Q

What can bladder stone do

A

Break of and obstruct catheter

55
Q

What are unilateral causes of hydronephrosis

A 
PACT 
Pelvic/ ureteric obstruction
Aberrant renal vessel
Calculi
Tumour
56
Q

What are bilateral causes

A 
SUPER
Stenosis urethra
Urethral valve
Prostatic enlragement
Extensive bladder tumour
Retroperitoneal fibrosis
57
Q

How is hydronephrosis picked up

A

USS

58
Q

How do you further investigate

A

CT

59
Q

How do you treat

A

Remove obstruction e.g. catheter
Nephrostomy if acute
Stent / pyeloplasty if chronic

60
Q

What is important to assess if bilateral kidney stone

A

U+E

61
Q

What does a balatobale mass in abdominal suggest

A

Hydronephrosis

62
Q

What is 1st line to investigate

A

USS to look for obstruction

Then CT for underlying cause

63
Q

Infection

A

EMERGENCY

64
Q

Why not contrast

A

As makes stone invisible as same colour

65
Q

What has replaced IVU for renal stone

A

CT KUB

66
Q

What needs urgent Rx with percutaneous nephrostomy or stent

A

Obstruction - bilateral or uni if single kidney
Infection / urosepsis
Intractable pain or vomit
Impending AKI

Renal / Urology (16 decks)

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