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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
What is a risk factor of struvite calculi?
Urinary tract infections
26
Which two urinary tract infections are most commonly associated with struvite calculi?
Ureaplasma urealyticum Proteus
27
Are struvite renal calculi radio-opaque or radio-lucent? What does this mean?
Radio-opaque This means that these calculi appear white on radiographs enabling monitoring of their movement throughout the renal tract
28
What is the urine acidity and mean pH in struvite renal calculi?
Urine acidity = Alkaline Mean pH = >7.2
29
How is uric acid produced?
Purine metabolism
30
What causes uric acid calculi formation?
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
31
What are the four risk factors of uric acid calculi?
Gout Adult Polycystic Kidney Disease Metabolism Deficiencies Ileostomy
32
Which patient group tend to be affected by uric acid calculi?
Children
33
Are uric acid calculi radio-opaque or radio-lucent? What does this mean?
Radio-lucent This means that these calculi appear black on radiographs and their movement throughout the renal tract cannot be monitored
34
What is the urine acidity and mean pH in uric acid renal calculi?
Urine acidity = Acidic Mean pH = < 5.5
35
What is a risk factor of cystine calculi?
Cystinuria
36
What is cystinuria?
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
What is the urine acidity and mean pH in cystine renal calculi?
Urine acidity = Normal Mean pH = 6.5
38
Are cystine calculi radio-opaque or radio-lucent? What does this mean?
Semi-opaque This means that these calculi have a ground glass appearance on radiographs enabling monitoring of their movement throughout the renal tract
39
What are the five renal stone classifications which are radio-opaque?
Calcium Oxalate Calculi Calcium Phosphate Calculi Mixed Calcium Oxalate/Phosphate Calculi Triple Phosphate Calculi Cystine Calculi
40
What are the two renal stone classifications which are radio-lucent?
Urate Calculi Xanthine Calculi
41
What are the six risk factors of renal calculi?
Male Gender Middle Aged, 30 – 55 Years Old Family History Dehydration High Sodium Diet Metabolic Conditions
42
Which two metabolic conditions are associated with renal calculi?
Inflammatory bowel disease Chronic diarrhoea
43
When do renal calculi become symptomatic?
When they move within the renal tract
44
What are the five clinical features associated with renal calculi?
Loin Pain Nausea & Vomiting Dysuria Haematuria Urinary Tract Infection Features
45
Describe the loin pain associated with renal calculi
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
What is dysuria?
It is defined as painful urination
47
What six investigations are used to diagnose renal calculi?
Blood Tests Urinalysis X-Ray Scan Ultrasound Scan Non-Contrast CT KUB Scan Chemical Analysis
48
What are the five blood tests used to diagnose renal calculi?
Increased WBC Levels Increased Calcium Levels Increased Parathyroid Hormone Levels Increased Creatinine Levels Increased Uric Acid
49
What are the six urinalysis results which indicate renal calculi?
Increased WBC Levels Increased Calcium Levels Increased Uric Acid Levels Increased Oxalate Levels Decreased Citrate Levels Haematuria
50
What are the two features of renal calculi on an x-ray scan?
Radio-Opaque Mass Radio-Lucent Mass
51
What is the first line investigation used to diagnose renal calculi?
Ultrasound scan
52
How is an ultrasound used to diagnose renal calculi?
It is used to diagnose and monitor the movement of radio-opaque renal calculi in the kidney
53
What are the two features of renal calculi on ultrasound scans?
Radio-Opaque Mass Hydronephrosis
54
What is hydronephrosis?
It is defined as dilatation of the kidney It is a clinical sign that it is not draining efficiently due to obstruction
55
Can renal calculi in ureters be detected on an ultrasound scan? Why?
No This is due to the presence of other organs anteriorly
56
What is the gold standard investigation used to diagnose renal calculi?
Non-contrast CT KUB scan
57
When should CT KUB scans be conducted to investigate renal calculi?
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
What are the two clinical features of renal calculi on a CT urogram scan?
Radio-Opaque Mass Hydronephrosis
59
How is chemical analysis of renal calculi conducted?
It involves asking patients to urinate through a strainer to catch stones that they pass
60
When is conservative management of renal calculi recommended?
It is recommended in small renal calculi < 5mm
61
What are the two conservative management options of renal calculi?
Observation Hydration
62
How long can it take small renal calculi to pass spontaneously?
Four weeks
63
What is the pharmacological management option of renal calculi?
NSAIDs
64
Name two NSAIDs used to manage renal calculi
Ibuprofen Diclofenac
65
Which analgesia should be administered in cases where renal calculi patients require secondary care admission?
IM diclofenac
66
What are the three surgical management options of renal calculi?
Extracorporeal Shock Wave Lithotripsy (ESWL) Percutaneous Nephrostomy Percutaneous Nephrolithotomy/ Ureteroscopy
67
What is the first line surgical management option of renal calculi in calculi < 2cm, with no obstructive features?
Extracorporeal Shock Wave Lithotripsy (ESWL)
68
Why is ESWL contraindicated in renal calculi > 2mm?
This is due to the fact that these calculi will be broken down into several small pieces, which may cause obstruction
69
What is ESWL?
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
Which calculi classification tend to be resistant to ESWL?
Struvite
71
When is percutaneous nephrolithotomy recommended?
It is used to manage large (>2cm), proximal renal calculi. It should also be considered in complex renal calculi and struvite calculi
72
What is percutaneous nephrolithotomy?
It involves intracorporal lithotripsy through endoscopic access to the renal collecting system The remaining stone fragments are then removed
73
When is percutaneous nephrostomy/ uteroscopy recommended to manage renal calculi?
It is recommended in when ESWL is contraindicated, such as pregnant patients or in cases with obstructive features (hydronephrosis)
74
What is the first line management option of renal calculi in pregnant women?
Ureteroscopy
75
What is ureteroscopy?
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
In which three circumstances are renal calculi deemed as surgical emergencies?
Ureteric obstruction Renal developmental abnormality Previous renal transplant
77
How do we manage renal calculi that have resulted in ureteric obstruction?
Decompression with nephrostomy tube placement, insertion of ureteric catheters or ureteric stent placement
78
What are the three prophylactic management options of calcium renal calculi?
Hydration Low Sodium Diet Thiazide Diuretics
79
What are the two specific prophylactic management options of calcium oxalate renal calculi?
Cholestyramine Pyridoxine
80
What are the two prophylactic management options of uric acid renal calculi?
Allopurinol Oral Bicarbonate

Year Two - Urinary System (15 decks)

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