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Urology > Kidney Stones > Flashcards

Kidney Stones Flashcards

1
Q

what are the risks associated with kidney stones?

A
  • Diet – chocolate, tea, rhubarb, strawberries, nuts, spinach
  • Season – vit D levels mediate calcium and oxalate levels
  • Work – dehydration
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2
Q

what medications are risk factors towards kidney stones?

A

diuretics, antacids, acetazolamide, corticosteroids, theophylline, aspirin, allopurinol, vit c and d, indinavir

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3
Q

what are the predisposing factors for kidney stones?

A
  • Recurrent UTIs
  • Metabolic abnormalities
  • Urinary tract abnormalities – pelviureteric junction obstruction, hydronephrosis, calyceal diverticulum, horseshoe kidney, ureterocoele, vesicoureteral reflux, ureteral stricture, medullary sponge kidney
  • Family history
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4
Q

what are the metabolic abnormalities associated with kidney stones?

A

o Hypercalciuria/hypercalcaemia: hyperparathyroidism, neoplasia, sarcoidosis, hyperthyroidism, Addison’s, Cushing’s, lithium, vitamin D excess
o Hyperuricosuria/plasma urate – on its own or with gout
o Hyperoxaluria
o Cystinuria
o Renal tubular acidosis

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5
Q

what are the urinary tract abnormalities associated with kidney stone development?

A

pelviureteric junction obstruction, hydronephrosis, calyceal diverticulum, horseshoe kidney, ureterocoele, vesicoureteral reflux, ureteral stricture, medullary sponge kidney

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6
Q

where do kidney stones tend to get stuck?

A

uteropelvic junction, vesicoureteral junction (VUJ), ureter, ureteric orifice

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7
Q

how do kidney stones form?

A
  • Stones form solute that precipitates and crystallises when solvents become supersaturated
  • Crystals act as nidus – a place where more solutes deposit, build-up = crystals
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8
Q

what are the different kinds of kidney stones?

A 
Calcium Phosphate
Calcium Oxalate
Uric Acid
Struvite (MagPhos)
Xanthine 
Cystine
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9
Q

what are the causes of calcium phosphate stones?

A

Metabolic or idiopathic

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10
Q

what are the causes of calcium oxalate stones?

A

Metabolic or idiopathic

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11
Q

what are the causes of uric acid stones?

A

Hyperuricaemia

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12
Q

what are the causes of struvite (magphos) stones?

A

UTI

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13
Q

what are the causes of cystine stones?

A

Renal tubular defect

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14
Q

what is the appearance of calcium phosphate stones?

A

Wedge, smooth dirty white colour

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15
Q

what is the appearance of calcium oxalate stones?

A

Envelope, spiky

Dark brown

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16
Q

what is the appearance of uric acid stones?

A

Diamond/rhomboid crystals, red/brown, small

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17
Q

what is the appearance of struvite stones?

A

Coffin lid shaped, staghorn, large

Dirty white

18
Q

what is the appearance of xanthine stones?

A

Red Brown

19
Q

what is the appearance of cystine stones?

A

Hexagonal crystals

Yellow/pink colour, semi opaque

20
Q

what is the pH of calcium phosphate stones?

A

> 5.5

21
Q

what is the pH of calcium oxalate stones?

A

6

22
Q

what is the pH of uric acid stones?

A

5.5

23
Q

what is the pH of struvite stones?

A

> 7.2

24
Q

what is the pH of cystine stones?

A

6.5

25
Q

what is the pathophysiology of uric acid stones?

A

Uric acid loses proton = urate ion, binds to sodium = monosodium urate

26
Q

what is the pathophysiology of struvite stones?

A

Bacteria uses urease to split urea into carbon dioxide and ammonia. Ammonia makes urine more alkaline. Precipitation of Mg, Ammonia and PO4.

27
Q

what is the pathophysiology of xanthine stones?

A

Biproduct or purine break down

28
Q

what is the pathophysiology of cystine stones?

A

Amino acid sometimes leaks into urine + crystallises

29
Q

what are the clinical features of kidney stones?

A 
asymptomatic 
renal colic
UTI 
Pyelonephritis
Haematuria
Proteinuria
Sterile Pyuria
Anuria 
Sepsis
30
Q

what are the clinical features of renal colic?

A

acute loin pain (radiates from flank to groin) with nausea/vomiting, restlessness

31
Q

what are the symptoms of kidney stones in renal obstruction?

A

– loin between rib 12 and lateral edge of lumbar muscles – pain not colicky but worse on movement

32
Q

what are the clinical features of kidney stones causing obstruction of mid ureter?

A

mimic appendicitis, diverticulitis

33
Q

what are the clinical features of kidney stones causing obstruction of lower ureter?

A

symptoms of bladder irritability and pain in scrotum/penis

34
Q

what are the clinical features of kidney stones causing obstruction of bladder or urethra?

A

pelvic pain, dysuria, strangury

35
Q

how are kidney stones diagnosed?

A
  • FBC, U&E, Ca, PO4, glucose, bicarbonate, urate
  • Urine dipstick +blood, pH
  • Imaging
36
Q

what is the imaging used in kidney stones?

A

o KUB X ray
o Spiral non contrast CT
o IVU – CT preferable
o US or MRI if pregnant or poor kidney function

37
Q

what is the supportive management of kidney stones?

A

ANALEGISA - Diclofenac, Codeine/morphine
Fluids
Antibiotics – cefuroxime, gentamicin)

38
Q

what is the management of kidney stones <5mm?

A

conservative - pass spontaneously

39
Q

what is the management of kidney stones >5mm?

A

Medical expulsive therapy
 Calcium Channel blockers – e.g. nifedipine
 α-receptor blockers – e.g. tamsulosin

40
Q

what is the management of kidney stones >1cm?

A

o Extracorporeal shockwave lithotripsy (ESWL)
o Ureteroscopy with basket
o Percutaneous nephrolithotomy

Urology (10 decks)

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