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Renal > Kidney Stones and Urinary Tract Obstruction > Flashcards

Kidney Stones and Urinary Tract Obstruction Flashcards

1
Q

What are the types of kidney stones?

A

Calcium Oxalate 40%

Mixed calcium/phosphate 25%

Triple phosphate 10%

Calcium phosphate 10%

Urate 5-10%

Cystine 1%

Xanthine < 1%

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2
Q

What is the most common type of kidney stone?

A

Calcium oxalate

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3
Q

Which stones are opaque on imaging?

A

Start of alphabet

Calcium oxalate

Mixed calcim oxalate/phosphate

Triple phosphate

Calcium phosphate

Cystine, semi opaque

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4
Q

Which stones are radio-luscent on imaging?

A

End of alphabet

Urate stones

Xanthine stones

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5
Q

Which stones are associated with acidic urine?

A

Uric acid

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6
Q

Which stones are associated with alkaline urine?

A

Struvate

Calcium phosphate

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7
Q

Which stones are associated with variable urine pH?

A

Calcium oxalate

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8
Q

Which stones are associated with normal pH?

A

Cystine

Calcium phosphate

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9
Q

What type of kidney stone is known as ‘stag horn’?

A

Struvite/triple phosphate

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10
Q

What is the prognosis of kidney stones?

A

50% will reoccur within 10 years

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11
Q

Which group are kidney stones more common?

A

M>F

3:1

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12
Q

What can cause kidney stones?

A

Idiopathic

Dehydration

Infection

Obstruction

Hyperparathyroidism, hypercalcaemia, hypercalciuria

Polycystic kidney disease

Renual tubular acidosis

Drugs

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13
Q

How do kidney stones present?

A

Asymptomatic

Severe colicky loin pain, radiating to groin, testicles/vulvula

N&V

Dysuria

Oliguria

Haematuria

Strangury

Persistent urinary infection

Pyrexia/signs of sepsis

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14
Q

What investigations are used in kidney stone diagnosis?

A

Urinalysis and culture

FBC and CRP for associated infection

U&E’s and creatinine

Ca2+ and urate to assess type ofs tone

Non contrast KUB CT within 14 hours of admission, diagnostic investigation

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15
Q

How are kidney stones managed?

A

NSAID/IM diclofenac

CCB can often be used to aid spontaneous passage of stones

Stones less than 5mm will pass within 4 weeks of symptom onset

Nephrostomy tube placement, insertion of ureteric catheters or ureteric stent placement in obsturction

Shockwave lithotripsy

Ureteroscopy and stenting

Percutaneous nephrolithotomy

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16
Q

What is appropriate management for stone burden of less than 2cm in aggregate?

A

Lithotripsy

17
Q

What is appropriate management for stone burden of less than 2cm in pregnant females?

A

Uteroscopy

18
Q

What is appropriate management for complex renal calculi and staghorn calculi?

A

Percutaneous nephrolithotomy

19
Q

What is appropriate management for ureteric calculi less than 5mm?

A

Manage expectantly

20
Q

How can renal stones be prevented?

A

Calcium

  • High fluid intake
  • Low salt diet
  • Thiazide diuretics

Oxalate

  • Cholestyramine reduces urinary oxalate secretion
  • Pyridoxine reduces urinary oxalate secretion

Uric acid

  • Allopurinol
  • Oral bicarbonate
21
Q

What pathogen is associated with staghorn kidney stones?

A

proteus mirabilius

22
Q

What are the 3 locations of upper urinary tract obstruction?

A

Pelvic-Ureteric Junction

Ureter

Vesico-Ureteric Junction

23
Q

What are the unilateral causes of urinary tract obstruction?

A

Pelvic-ureteric obstruction (congenital or acquired)

Aberrant renal vessels

Calculi

Tumours of renal pelvis

24
Q

What are the bilateral causes of urinary tract obstruction?

A

Stenosis of the urethra

Urethral valve

Prostatic enlargement

Extensive bladder tumour

Retro-peritoneal fibrosis

25
Q

How does upper urinary tract obstruction present?

A

Pain

Frank or microscopic haematuria

Palpable mass

Infection

Renal failure

26
Q

What investigations are used in urinary tract obstruction diagnosis?

A

US

  • Identifies presence of hydronephrosis and can assess the kidneys

IVU

  • Assess the position of the obstruction

Antegrade or retrograde pyelography

  • allows treatment

CT scan if suspect renal colic/stones

27
Q

How is urinary tract obstruction managed?

A

Remove the obstruction and drainage of urine

Acute upper urinary tract obstruction

  • Nephrostomy tube

Chronic upper urinary tract obstruction

  • Ureteric stent or a pyeloplasty

Renal (10 decks)

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