OnlineMedEd: Nephrology - "Kidney Stones" Flashcards

1
Q

Describe the presentation of kidney stones.

A
  • Colicky flank pain that radiates to the groin
  • Hematuria
  • No fever
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2
Q

Review the workup for suspected kidney stone.

A

• Patient presents with colicky flank pain that radiates to the groin and doesn’t have fevers

  • First, do a UA: if there is no microscopic hematuria, then they do not have a kidney stone (the contractions of the ureter will almost always lead to bleeding in the urine).
  • Second, if they have microscopic hematuria then do a non-contrast CT of the abdomen (which is the best test).

Note: if the patient is pregnant, do an ultrasound instead of the NC CT.

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3
Q

Go through the management of kidney stones by size of stone.

A
  • Less than 5 mm: IVF and pain medication
  • 5 mm - 7 mm: medical expulsive therapy (CCBs, terazosin)
  • 7 mm - 1.5 cm: lithotripsy for proximal stones, ureteroscopy for distal stones
  • Greater than 1.5 cm: surgery (distal = percutaneous anterograde nephroscopy; proximal = laparoscopy)
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4
Q

For stones that are expelled, review the follow-up protocol.

A
  • Modify risk factors: drink more water
  • Strain urine to definitively identify the stone
  • Have them come back in 6 weeks to screen urine for blood and stones.
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5
Q

Go through the following for calcium oxalate stones:
•Radiolucency:
•Risk factors:
•Preventive management:

A
  • Radiolucency: opaque
  • Risk factors: increased protein intake
  • Preventive management: decrease oxalate (less protein, less spinach); increase citrate (more fruits and veggies), and thiazide diuretics
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6
Q

Go through the following for struvite (MAP) stones:
•Radiolucency:
•Risk factors:
•Preventive management:

A
  • Radiolucency: opaque
  • Risk factors: Proteus infection
  • Preventive management: surgery and antibiotics
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7
Q

Go through the following for uric acid stones:
•Radiolucency:
•Risk factors:
•Preventive management:

A
  • Radiolucency: lucent
  • Risk factors: gout, tumor lysis syndrome
  • Preventive management: allopurinol for gout or TLS; rasburicase for treatment
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8
Q

Go through the following for cystine stones:
•Radiolucency:
•Risk factors:
•Preventive management:

A
  • Radiolucency: lucent
  • Risk factors: cystinuria
  • Preventive management: ???
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