Paulson - Nephrolithiasis Case Flashcards
possible presentation of nephrolithiasis (3)
sudden, intense, episodic pain
n/v
hematuria
PE finding of nephrolithiasis
CVA tenderness
preferred imaging for nephrolithiasis
CT A/P w.o contrast
CT findings of nephrolithiasis
hydronephrosis
stone
2nd line imaging for nephrolithiasis
US of kidneys/bladder
2 meds for nephrolithiasis pain
NSAIDs
opioids
med that is used in ED for nephrolithiasis
toradol
relieves pain w.in 10-30 min
3 indications for opioids in nephrolithiasis
NSAID contraindication
severe renal dz
unresponsive to NSAID
passage of stone depends on
size
stones __ mm or less usually pass spontaneously
5
stones __ mm or larger probably won’t pass spontaneously
10
indication for medical expulsive therapy
stones btw 5-10 mm
1st line med for medical expulsive therapy
tamsulosin (flomax) up to 4 weeks
besides tamsulosin (flomax), 2 other meds that can be used for medical expulsive therapy
CCB → nifedepine
PDE5 inhibitor → tadalafil
3 indications for admit for nephrolithiasis
PO intolerance
uncontrollable pain
fever
6 indications for urology consult for nephrolithiasis
UTI
AKI
anuria
persistent/unyielding pain or n/v
stone does not pass x 4 weeks
stone > 10 mm
pt ed for outpt management of nephrolithiasis
strain urine for stone analysis
4 types of stone
calcium oxalate
calcium phosphate
uric acid
struvite
mc type of stone
calcium oxalate
how do struvite stones form
only in presence of urease producing bacteria
4 urease-producing bacteria
proteus mirabilis
klebsiella pneumoniae
corynebacterium species
ureaplasma ureaylticum
