Nephro - Kidney stones - Online MedEd Flashcards
Presentation kidney stone
Colicky flank pain radiate to groin
Hematuria
Without fever or mass usually
-Pain is due to peristalsis in ureter on kidney stone
What is first step in work up of kidney stone?
Urinalysis - no microscopic hematuria, probably not a stone
Usually microscopic hematuria with stone
What is next step of kidney stone after U/A
Non-con CT scan is best
Also options for US and KUB
-If have to pick one, pick non-con CT (gold standard)
-Look for stone itself (radio-opaque) or look for hydronephrosis
-US not great for stones
-Pregnancy cannot do non-con CT
-Do US in pregnancy
-KUB can be used to track resolution of stone, not as great as CT
-If non-con CT shows no hydro or stone –> likely something else
-If it does show either hydro or stone –> it is kidney stone
Remember what sizes of stone
<5mm
>3cm
<5mm stones
IVF to flush out stone
Pain meds
> 3cm stones
Surgery
In between the sizes of 5mm and 3cm is what treatment option
Lithotripsy - patient in tub, use US waves pound on flank, pass through urethra
Lithotripsy for proximal stones
Ureteroscopy for distal stones - put a camera into the ureter to look at it
-So stones in between - break it up
Also less than 7mm do what?
IVF and pain meds, also medical expulsive therapy
-Do something to get stone out –> CCB (amlodipine) or alpha-blocker (tamsulosin/BPH meds)
> 1.5 cm stone what to do?
Surgery
Proximal - laparoscopic surgery (not open)
Distal - PAN (percutaneous anterograde nephrolithotomy
Septic - what to do?
Put in a nephrostomy tube (proximal)
Stent for distal stone
What does the patient need to do post-treatment?
Strain urine
To determine the type of stone, to modify the risk factors
When does patient need to return
in 6 weeks for screen
Types of stones are…
If have lots of volume, will decrease likelihood of stone formation
1) Calcium oxalate (most common)
2) Struvite
3) Uric acid stones
4) Cysteric stones
Calcium oxalate stones
Most common 85%
Radio-opaque
Increased Ca and increased oxalate in urine
Treatment: give thiazide diuretics
Decrease oxalate (red meet), increase citrate (veggies and fruits)
Struvite stones
Magnesium, ammonium, phosphate
Radio-opaque
Caused by UTIs (proteus - urea splitting activity)
Manage aggressively
Staghorn stones - all in kidney and don’t pass on own
-Need surgery to remove all stone burden
