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Year Two - Urinary System > Renal Calculi > Flashcards

Renal Calculi Flashcards

1
Q

What are two other terms for renal calculi?

A

Nephrolithiasis

Urothliasis

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2
Q

What are renal calculi?

A

They are stones which form in the renal tract

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3
Q

What are the two general causes of renal calculi?

A

When urine becomes concentrated, allowing minerals and salts to crystallise and stick together

When urine lacks substances that prevent these crystals from sticking together

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4
Q

How are renal calculi classified?

A

They are classified upon the minerals and salts they are formed of

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5
Q

Why is renal calculi classification important?

A

This classification is useful in determining the cause of the renal calculi, therefore enabling clinicians to identify how the patient can reduce the risk of reoccurrence

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6
Q

What are the five classifications of renal calculi?

A

Calcium Oxalate

Calcium Phosphate

Struvite Calculi

Uric Acid Calculi

Cystine Calculi

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7
Q

What is the most common classification of renal calculi? What is the percentage of cases?

A

Calcium oxalate (85%)

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8
Q

What are the two sources of calcium oxalate?

A

It is produced physiologically by the liver

It is absorbed from the diet

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9
Q

What are the eight risk factors of calcium oxalate renal calculi?

A

Hypercalcaemia

Hypercalciuria

Hyperoxaluria

Hypocitraturia

Hyperparathyroidism

Medullary Sponge Kidney

Adult Polycystic Kidney Disease

Drug Administration

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10
Q

Which four drugs are associated with calcium renal calculi?

A

Loop diuretics

Steroids

Acetazolamide

Theophylline

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11
Q

Which drug class prevent calcium renal calculi?

A

Thiazide diuretics

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12
Q

How is hypercitraturia associated with calcium oxalate renal calculi?

A

This is due citrate forming complexes with calcium making it more soluble

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13
Q

Are calcium oxalate renal calculi radio-opaque or radio-lucent? What does this mean?

A

Radio-opaque

This means that these calculi appear white on radiographs enabling monitoring of their movement throughout the renal tract.

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14
Q

What is the urine acidity and mean pH in calcium oxalate renal calculi?

A

Urine acidity = variable

Mean pH = >6

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15
Q

What is the shape of calcium oxalate calculi?

A

Envelope

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16
Q

What are the two sources of calcium phosphate?

A

It is produced physiologically by the liver

It is absorbed from the diet

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17
Q

What are the four risk factors associated with calcium phosphate renal calculi?

A

Renal Tubular Acidosis Type One

Renal Tubular Acidosis Type Three

Medullary Sponge Kidney

Drug Administration

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18
Q

Are calcium phosphate renal calculi radio-opaque or radio-lucent? What does this mean?

A

Radio-opaque

This means that these calculi appear white on radiographs enabling monitoring of their movement throughout the renal tract

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19
Q

Which renal calculi are more radio-opaque - calcium oxalate or calcium phosphate?

A

Calcium phosphate

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20
Q

What is the urine acidity and mean pH in calcium phosphate renal calculi?

A

Urine acidity = normal

Mean pH = 6.5

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21
Q

What is another term for struvite calculi?

A

Staghorn calculi

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22
Q

What is struvite calculi composed of?

A

Magnesium

Ammonium

Phosphate

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23
Q

Where do struvite calculi tend to form?

A

They involve the renal pelvis and extend into at least 2 calyces

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24
Q

What is struvite?

A

It is magnesium ammonium phosphate mineral produced by bacteria in the urinary tract under alkaline conditions

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25
Q

What is a risk factor of struvite calculi?

A

Urinary tract infections

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26
Q

Which two urinary tract infections are most commonly associated with struvite calculi?

A

Ureaplasma urealyticum

Proteus

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27
Q

Are struvite renal calculi radio-opaque or radio-lucent? What does this mean?

A

Radio-opaque

This means that these calculi appear white on radiographs enabling monitoring of their movement throughout the renal tract

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28
Q

What is the urine acidity and mean pH in struvite renal calculi?

A

Urine acidity = Alkaline

Mean pH = >7.2

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29
Q

How is uric acid produced?

A

Purine metabolism

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30
Q

What causes uric acid calculi formation?

A

They are calculi that form when the levels of uric acid in the urine are elevated, resulting in urine becoming acidic at a pH less than 5.5

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31
Q

What are the four risk factors of uric acid calculi?

A

Gout

Adult Polycystic Kidney Disease

Metabolism Deficiencies

Ileostomy

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32
Q

Which patient group tend to be affected by uric acid calculi?

A

Children

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33
Q

Are uric acid calculi radio-opaque or radio-lucent? What does this mean?

A

Radio-lucent

This means that these calculi appear black on radiographs and their movement throughout the renal tract cannot be monitored

34
Q

What is the urine acidity and mean pH in uric acid renal calculi?

A

Urine acidity = Acidic

Mean pH = < 5.5

35
Q

What is a risk factor of cystine calculi?

A

Cystinuria

36
Q

What is cystinuria?

A

It is a recessive genetic disorder that results in dysfunction of the transmembrane cystine transporter leading to decreased absorption of cystine from the intestine and renal tubule

37
Q

What is the urine acidity and mean pH in cystine renal calculi?

A

Urine acidity = Normal

Mean pH = 6.5

38
Q

Are cystine calculi radio-opaque or radio-lucent? What does this mean?

A

Semi-opaque

This means that these calculi have a ground glass appearance on radiographs enabling monitoring of their movement throughout the renal tract

39
Q

What are the five renal stone classifications which are radio-opaque?

A

Calcium Oxalate Calculi

Calcium Phosphate Calculi

Mixed Calcium Oxalate/Phosphate Calculi

Triple Phosphate Calculi

Cystine Calculi

40
Q

What are the two renal stone classifications which are radio-lucent?

A

Urate Calculi

Xanthine Calculi

41
Q

What are the six risk factors of renal calculi?

A

Male Gender

Middle Aged, 30 – 55 Years Old

Family History

Dehydration

High Sodium Diet

Metabolic Conditions

42
Q

Which two metabolic conditions are associated with renal calculi?

A

Inflammatory bowel disease

Chronic diarrhoea

43
Q

When do renal calculi become symptomatic?

A

When they move within the renal tract

44
Q

What are the five clinical features associated with renal calculi?

A

Loin Pain

Nausea & Vomiting

Dysuria

Haematuria

Urinary Tract Infection Features

45
Q

Describe the loin pain associated with renal calculi

A

It is characterised by severe, sharp pain in the upper lateral abdomen, back or groin

It tends to occur in waves, fluctuating in intensity

46
Q

What is dysuria?

A

It is defined as painful urination

47
Q

What six investigations are used to diagnose renal calculi?

A

Blood Tests

Urinalysis

X-Ray Scan

Ultrasound Scan

Non-Contrast CT KUB Scan

Chemical Analysis

48
Q

What are the five blood tests used to diagnose renal calculi?

A

Increased WBC Levels

Increased Calcium Levels

Increased Parathyroid Hormone Levels

Increased Creatinine Levels

Increased Uric Acid

49
Q

What are the six urinalysis results which indicate renal calculi?

A

Increased WBC Levels

Increased Calcium Levels

Increased Uric Acid Levels

Increased Oxalate Levels

Decreased Citrate Levels

Haematuria

50
Q

What are the two features of renal calculi on an x-ray scan?

A

Radio-Opaque Mass

Radio-Lucent Mass

51
Q

What is the first line investigation used to diagnose renal calculi?

A

Ultrasound scan

52
Q

How is an ultrasound used to diagnose renal calculi?

A

It is used to diagnose and monitor the movement of radio-opaque renal calculi in the kidney

53
Q

What are the two features of renal calculi on ultrasound scans?

A

Radio-Opaque Mass

Hydronephrosis

54
Q

What is hydronephrosis?

A

It is defined as dilatation of the kidney

It is a clinical sign that it is not draining efficiently due to obstruction

55
Q

Can renal calculi in ureters be detected on an ultrasound scan? Why?

A

No

This is due to the presence of other organs anteriorly

56
Q

What is the gold standard investigation used to diagnose renal calculi?

A

Non-contrast CT KUB scan

57
Q

When should CT KUB scans be conducted to investigate renal calculi?

A

It should be performed on all patients within 14 hours of admission

However, in cases where a patient has a fever, solitary kidney or when the diagnosis is unclear it should be conducted immediately

58
Q

What are the two clinical features of renal calculi on a CT urogram scan?

A

Radio-Opaque Mass

Hydronephrosis

59
Q

How is chemical analysis of renal calculi conducted?

A

It involves asking patients to urinate through a strainer to catch stones that they pass

60
Q

When is conservative management of renal calculi recommended?

A

It is recommended in small renal calculi < 5mm

61
Q

What are the two conservative management options of renal calculi?

A

Observation

Hydration

62
Q

How long can it take small renal calculi to pass spontaneously?

A

Four weeks

63
Q

What is the pharmacological management option of renal calculi?

A

NSAIDs

64
Q

Name two NSAIDs used to manage renal calculi

A

Ibuprofen

Diclofenac

65
Q

Which analgesia should be administered in cases where renal calculi patients require secondary care admission?

A

IM diclofenac

66
Q

What are the three surgical management options of renal calculi?

A

Extracorporeal Shock Wave Lithotripsy (ESWL)

Percutaneous Nephrostomy

Percutaneous Nephrolithotomy/ Ureteroscopy

67
Q

What is the first line surgical management option of renal calculi in calculi < 2cm, with no obstructive features?

A

Extracorporeal Shock Wave Lithotripsy (ESWL)

68
Q

Why is ESWL contraindicated in renal calculi > 2mm?

A

This is due to the fact that these calculi will be broken down into several small pieces, which may cause obstruction

69
Q

What is ESWL?

A

It involves the use of sound waves to create strong vibrations that break the renal calculi into tiny pieces that can be passed in the urine

70
Q

Which calculi classification tend to be resistant to ESWL?

A

Struvite

71
Q

When is percutaneous nephrolithotomy recommended?

A

It is used to manage large (>2cm), proximal renal calculi.

It should also be considered in complex renal calculi and struvite calculi

72
Q

What is percutaneous nephrolithotomy?

A

It involves intracorporal lithotripsy through endoscopic access to the renal collecting system

The remaining stone fragments are then removed

73
Q

When is percutaneous nephrostomy/ uteroscopy recommended to manage renal calculi?

A

It is recommended in when ESWL is contraindicated, such as pregnant patients or in cases with obstructive features (hydronephrosis)

74
Q

What is the first line management option of renal calculi in pregnant women?

A

Ureteroscopy

75
Q

What is ureteroscopy?

A

It involves the passage of an ureteroscope through the ureter and into the renal pelvis to enable placement of a stent in situ for a period of four weeks

76
Q

In which three circumstances are renal calculi deemed as surgical emergencies?

A

Ureteric obstruction

Renal developmental abnormality

Previous renal transplant

77
Q

How do we manage renal calculi that have resulted in ureteric obstruction?

A

Decompression with nephrostomy tube placement, insertion of ureteric catheters or ureteric stent placement

78
Q

What are the three prophylactic management options of calcium renal calculi?

A

Hydration

Low Sodium Diet

Thiazide Diuretics

79
Q

What are the two specific prophylactic management options of calcium oxalate renal calculi?

A

Cholestyramine

Pyridoxine

80
Q

What are the two prophylactic management options of uric acid renal calculi?

A

Allopurinol

Oral Bicarbonate

Year Two - Urinary System (15 decks)

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