Nephro-urolithiasis (STONES) Flashcards
When are men and women most likely to get kidney stones?
- Peak age in men is 30
- Women peak at 35 and then again at 55
What is the relative incidence of different stone types?
Calcium oxalate 45%
Calcium oxalate + phosphate 25%
‘Triple phosphate’ (infective) 20%
What is “colic” in terms of the renal system?
a type of pain you get when urinary stones block part of your urinary tract
What are some symptoms and signs of Nephro-urolithiasis (kidney stones)?
- Renal pain fixed in loin
- Ureteric colic (radiating to loin)
- Dysuria / haematuria
- Testicular or vulval pain
- Urinary infection
- Loin tenderness
- Pyrexia
What are some non-radiological investigations for suspected Nephro-urolithiasis (stones)?
- 97% have microscopic haematuria
- Bloods: FBC, U&E, Creatinine
- Calcium, albumin, urate
- Parathormone
- Urine analysis and culture
- 24h urine collection
What are some radiological investigations for suspected Nephro-urolithiasis (stones)?
- CT KUB (kidney/ureter/bladder) - gold standard
- IVU scan (intravenous urogram)
- USS
What are some indications for surgery for patients with kidney stones?
Obstruction.
Recurrent gross haematuria.
Recurrent pain and infection.
Progressive loss of kidney function.
What are the treatment options for patients with kidney stones causing significant side effects?
- E.S.W.L. (Extracorporeal Shock Wave Lithotripsy)
- PCNL (Percutaneous Nephrolithotomy)
- Open surgery
What are some indications for open surgery to treat nephro-urolithiasis?
- Non functioning infected kidney with large stones necessitating nephrectomy.
- Technical reasons obstruct use of PCNL or ESWL
What are two examples of open surgery to remove kidney stones?
- Simple Pyelolithotomy (incision made at renal pelvis)
- Simple Radial Nephrotomy
What is PCNL? When is it used? Give a brief description.
- Percutaneous Nephrolithotomy: a scope is inserted into the back of the patient and into the kidney, where it can remove the stone
- Indicated for large stones (>2cm diameter) or when stones are blocking more than one branch of the collecting system of the kidney
What are some contraindications for PCNL?
Uncorrected coagulopathy.
Active Urinary Tract Infection.
Obesity or body unsuitable for X-ray tables.
Small kidneys and severe perirenal fibrosis.
What is ESWL? When is it indicated?
- Extracorporeal shock wave lithotripsy: uses shock waves to break kidney stones into smaller pieces that may pass through the urinary system
- First line treatment for stones > 2cms
What type of stones are not particularly responsive to ESWL?
Stones with high cystine content
What is the standard treatment for lower ureteric stones?
- Ureteroscopy
- Involves passing a ureteroscope into the urethra and then through to the bladder and then on into the ureter (and kidney if needed)
- 90-100% success rate for lower ureteric stones