Nephrolithiasis Flashcards
What is the most common cause of nephrolithiasis?
Dehydration/poor fluid intake
What are the 3 most common types of renal stones? Mention the most common and whether each is radioluscent or radio-opaque
80% are Calcium oxalate stones (opaque)
uric acid stones (luscent)
Struvite stones (opaque)
When saying something is radio-luscent or radio-opaque, what imaging are we referring to?
X-ray (which is not used anymore. Used to be used in the form of X-ray KUB and IV pyelogram)
What are the 2 most common causes of Struvite crystals
Proteus infection
Klebsiella infection
Which type of renal stone is somewhere in between radioluscent and radio-opaque?
Cysteine stones
What are the different types of urinary tract stones?
State which types are radioluscent
radio-opaque
What findings on the 24-hour urine collection would you be looking for in a patient with nephrolithiasis
Hypercalciuria
Hyperoxaluria
Hyperuricosuria
Hypomagnesuria
Cysteinuria
Give the causes/rf for nephrolithiasis
How does nephrolithiasis present? (incl. signs)
Signs:
Renal angle tenderness
Suprapubic tenderness
What is the first line imaging for nephrolithiasis? (or technically for painful haematuria)
Can it pick up all the types of stones?
US and it can pick up all types of stones
What is the gold standard investigation for nephrolithiasis?
CTKUB
Is a CTKUB contrast or non-contrast and why?
Non-contrast CT as the contrast in the port-venous phase will mask the stones
Is CT urogram contrast or non-contrast?
Why would you order that in a case of nephrolithiasis?
Contrast
Assessing the (arterial-ischaemic but not rly), Parenchymal and venous phase for other obstructions that may be causing stasis or preventing small stones form passing e.g. ureteric stones
How is contrast given for a CT urogram
IV most likely (still eliminated through urinary tract)
Oral contrast theoretically
What imaging investigations would you order for a patient with nephrolithiasis?
Renal US
CTKUB
Contrast CT Urogram
Patient has recurrent kidney stones that are not being passed needing several lithotripsy. What is the most ideal way of addressing this?
Nephrostomy
What is the full list of investigations for nephrolithiasis
What are the complications of nephrolithiasis?
What is the first line management of uric acid stones?
It is the only stone with medical therapy which is dissolving with sodium bicarbonate or potassium citrate
What is the conservative management for nephrolithiasis in the hospital? When is that indicated?
What is the management of the emergency presentation of nephrolithiasis?
This is a case of acute urinary retention
US for hydronephrosis
CTKUB for stone confirmation
1) Attempt inserting urinary catheter (foley or suprapubic)
2) Anterograde or retrograde insertion of JJ ureteric stent
3) IR Nephrostomy insertion
What is the first-line surgical management of nephrolithiasis and what are the ways it can be done
Ureteroscopy with laser or pneumatic lithotripsy
What does lithotripsy mean?
Procedure that breaks down stones
What surgical management of nephrolithiasis can be done in the OPD and under what circumstances?
Extra-corporeal shockwave lithotripsy can be performed in the OPD setting but requires multiple sessions. It is used as second line for small stones and CI for larger stones and complete stenosis
What surgical options are available for patients with nephrolithiasis? (must be in order of escalation
Ureteroscopy with laser or pneumatic lithotripsy
Extra-corporeal shockwave lithotripsy
Percutaneous Nephrolithotomy
Open/lap stone surgery
What is the full management of a patient presenting with nephrolithiasis from when it has been diagnosed
