Nephro-Stones Flashcards
Best way to diagnosis kidney stones?
Non-contrast helical CT is the best because it detects all stones and anatomic changes–but exposes to radiation and is contraindicated in pregnant women
If stones are radiopaque then use can use XR imaging
US being used for pregnant women and if CT cannot be done for any particular reason
What are ways to prevent calcium oxalate stones?
Thiazide diuretics
What is the most common kidney stone?
calcium oxalate
What are hyperoxaluria stones?
can predispose to calcium oxalate stones
excess oral intake of oxalates causes it (rhubarb, chocolate, green and black tea, roux-en-y due to malabsorption issues)
What are hypocitrauria stones?
bind calcium in the tubular luminary’s, preventing it from precipitating with oxalate
What are struvite stones?
magnesium ammonium phosphate and calcium carbonate-apatite
**Occur in the presence of urea-splitting bacteria such as Proteus or Klebsiella in the upper urinary tract
How do you manage struvite stones?
You treat infections from urea-splitting organisms
Once stones form, antibiotic therapy is less effective, especially for large stones… and so surgical removal provides definitive therapy
How do you manage uric acid stones? How treated?
uncommon, can occur with gout and DM
increased indigence in hotter, arid climates due to low urine volumes
Treat with allopurinol, lots of fluid
How do you manage cystine stones?
occur in cystinuria, HEXAGONAL crystals in urine, cystine stones can become large and form stag horn calculi
What is the ACUTE management for kidney stones?
Pain control, hydration, look for coincident infection
Hospitalization if there is ureteral obstruction with a urinary tract infection or high risk (solitary or transplanted kidney)
Stones <10mm, manage conservatively with the above and can use tamsulosin or nifedipine to help
What is the UROLOGIC management of kidney stones?
Urologic consolation is necessary for patients with urosepsis, AKI, anuria, refractory pain, or large stones requiring surgical removal
Who needs a perc neph tube or stenting?
Urgent decompression with perc nephritis tube is needed for bilateral obstruction, pyelonephritis, or obstruction of a solitary kidney
When is lithotripsy indicated?
Used for stones in the renal pelvis and proximal ureter
How do you get proximal and mid-ureteral stones?
percutaneous anterograde approach or RP laparoscopy or ureteroscopy
What is the gold standard treatment for stag horn calculi?
Surgical removal
