Kidney Stones Flashcards
What are the most common–> least common types of stones found in renal tract?
- Calcium oxalate
- calcium phosphate
- struvite
- uric acid
- cysteine
outline what the following types of stones are most associated with:
- calcium oxalate
- struvite
- uric acid
- cysteine
- calcium oxalate
- high conc of calcium
- struvite
- infection, mainly proteus and klebsiella
- uric acid
- high conc of uric acid in blood ie gout
- cysteine
- usually secondary to the genetic disorder cystinuria
What are staghorn calculi?
branched stones that fill all or part of renal pelvis and extend into several calyces
what is the main composition of Staghorn calculi?
Struvite
presentation?
- asymptomatic if small
- renal colic
- loin to groin pain
systemically:
- nausea & vomiting
- fever if infection present
- haematuria, oliguria
Ix?
Bedside:
- urine dip +/- MSU, bHCG
Bloods:
- FBC
- UE
- CRP
- Ca
- Phosphate
- Urate
Imaging: Non-contrast CTKUB
what is the sensitivity of CTKUB in picking up renal stones?
80%
outline what stones are radioopaque / radiolucent and hence which ones are seen on plain x-ray and not
- calcium oxalate / phopshate
- radioopaque
- can be seen
- struvite
- radiopaque
- can be seen
- uric acid
- radiolucent
- not visible on XRay
Initial Mx?
- Prompt analgesia
- NSAIDs better than opiates but check renal function first - IM Diclofenac
- Fluids
- anti-emetics if vomiting
- antibiotics if infection
Definitive Mx?
Small stone (<5mm) & no complications
- conservative - watch & wait
- spontaneous passage can take several weeks
- medical mx: tamsulosin can help aid spontaneous passage of stones
Large stones / stones that do not pass –> Surgical Mx
Options for surgical treatment? (from least –> most invasive)
- ESWL (extra corporeal shockwave lithotripsy)
- Ureteroscopy & laser lithotripsy
- Percutaneous Nephrolithotomy
- Open surgery
in what case would you do a nephrectomy?
non-functioning kidney with staghorn stones
when do bladder stones usually arise? and how can they be reated if large?
- usually secondary to outlfow obstruction
- open excision
Advice to prevent further episodes of stones recurring?
- increase oral fluids
- reduce dietary salt intake
- reduce oxalate-rich foods for calcium stones
- reduce intake of urate for uric acid stones
Points where stones most likely to get stuck & cause obstruction?
at points of narrowest passage:
- PUJ
- VUJ
- Sacroiliac joints
