Nephrolithiasis - JRB Flashcards
Are renal calculi more common in men or women?
males (3:1)
Are struvite stones (due to infection) more common in males or females?
Females (due to ↑ tendency for chronic UTI)
Is Nephrolithiasis a common cause of renal failure?
No
What is the most common type of calculi? (chemical composition)
calcium oxalate (75%)
followed by struvite calculi (15%)
What are the steps in the pathophysiology of calculi formation
1) Saturation
2) Supersaturation
3) Nucleation
4) Crystal growth & aggregation
5) Crystal retention
6) Stone formation
What is the clinical presentation of nephrolithiasis?
- Sudden onset of severe flank pain & radiates inferior and anterior
- Fever/chills if co-existing infection
- N/V
- may be asymptomatic
What will the PE reveal in a patient with nephrolithiasis?
- CVA tenderness
- Abdominal exam unremarkable
- Frequent body repositioning
- Tachycardia
- HTN
- Hematuria (gross or microscopic)
What labs will be ordered for a patient with nephrolithiasis?
- U/A w/ culture
- microscopic U/A
- CBC with Diff (if febrile)
- Electrolytes
- Serum Creatinine
- Urinary pH
- 24 hr urine sample to ID stone composition
What imaging studies can be ordered for a patient with nephrolithiasis?
- Non-contrast CT → modality of choice
- Renal U/S (children & pregnant Pt)
- KUB (often used in conjunction w/ other imaging)
- IVP
- Retrograde pyelography (most precise for ureter and renal pelvis)
- Plain renal tomography
What would the management of a patient with nephrolithiasis be?
1) Supportive care with IV hydration and non-narcotic pain relief
2) Alpha-blocker to assist in passage of stone
3) Abx if concurrent infection is suspected
4) Antiemetics for N/V
5) If stone is > 5 mm, consider additional interventions
What are examples of interventional therapy for nephrolithiasis?
1) ureteroscopy
2) ESWL
3) Percutaneous nephrolithotomy
