Nephrolithiasis

Question 1

What signs and symptoms would lead you to suspect nephrolithiasis?

Answer 1

flank pain (90%), hematuria (75% to 95%), gross hematuria (22% to 25%), and pyuria (40%)

Question 2

In patient with nephrolithiasis, what is your initial work-up?

Answer 2

renal ultrasound

Question 3

What is the accuracy of renal and pelvic ultrasound in identifying renal calculus in pregnant patient?

Answer 3

60% sensitive

Question 4

If renal ultrasound does not identify a calculus, what is your next step in the patient?

Answer 4

If further diagnostic tests are needed, magnetic resonance urography should be considered. Low-dosage computer tomography has high sensitivity and specificity with relatively low risk for fetal harm, but it should be considered only if other measures are inconclusive

Question 5

How do you manage a pregnant patient with nephrolithiasis?

Answer 5

• hydration
• lying on the non-affected side to relieve pressure
• adequate antibiotic therapy
• pain management
• 75% to 80% of stones pass spontaneously as a result of the dilated state of the ureter in pregnancy

Question 6

What patient are candidates for more aggressive interventions in nephrolithiasis?

Answer 6

When sepsis, severe refractory pain, or obstruction develop in a single functioning kidney, further therapy such as cystoscopy with stent or nephrostomy tube placement is indicated

Question 7

What are potential complications of nephrolithiasis in pregnancy?

Answer 7

AKI
Kidney infection
Need for surgical intervention