RENAL CALCULI Flashcards
True or False
Men are more frequently affected by urolithiasis than women, with a ratio of 2.5:1
True
The initial presentation predominates between what decades of life?
Third and fifth decade
How many major types of urinary stones are there?
Five
The most common types of urinary stones are composed of what?
85% calcium
Are most urinary stones radiopaque (visible) on plain abdominal radiographs?
Yes
What time of year are ureteral stones most symptomatic?
hot summer months
Higher incidence rates of stones have also been associated with what?
- sedentary lifestyle
- HTN
- carotid calcification
- Cardiovascular disease
What are the most important dietary factors in the development of urinary stones?
- High protein and salt intake
2. inadequate hydration
What are these signs and symptoms of?
- Pain that occurs suddenly
- typically localized to flank
a. may have nausea/vomiting
b. pts will constantly move and try to find a comfortable position - pain may be episodic and radiate anteriorly over the abdomen
a. stone progression down ureter, pain may be referred into ipsilateral groin - obstructing stones present with acute, unremitting and severe colic
- minimal pain with passage through urethra
- stone size doesn’t correlate with severity of symptoms
Renal calculi (urinary stone)
In 90% of the cases with patients with a possible urinary stone a urinalysis usually reveals what?
microscopic or gross hematuria
Does the absence of hematuria exclude urinary stones?
NO
What is a valuable clue in the urinalysis into the cause of the possible stone?
Urinary pH
What imaging should be used for the diagnosis of urinary stones?
- plain abdominal radiograph (KUB)
- renal ultrasound
- spiral ct with pt in prone position
A KUB plain abdominal radiograph along with a renal ultrasound will diagnose up to what percentage of stones?
80%
Can forced diuresis be counterproductive and exacerbate pain for a patient with a urinary stone?
Yes
Stones smaller that how many mm’s in diameter on a plain abdominal radiograph usually pass spontaneously?
5-6mm
What kind of meds could you use to help increase the rate of spontaneous stone passage and is most effective for distal stones?
- Tamsulosin (alpha-blocker) 0.4mg PO once daily
- Ibuprofen 800mg PO TID
- Prednisone 10mg PO daily 3-5 days
Stones that require surgical removal include those that are showing signs of what?
obstruction or infection
What are some procedures for urinary stone removal?
- Ureteroscopic stone extraction
2. Extracoporeal shock wave lithotripsy
What is the greatest method of importance in reducing urinary stone recurrence?
increased fluid intake
Sodium intake should be restricted to keep urinary sodium levels less that what?
150mEq/day
Animal protein intake should be spread throughout the day and limited to how much daily?
1g/kg/day
True or False
Obstructing stones with associated infections are medical emergencies (MEDEVAC)
True
True or False
Obstructing stones with associated infections require urology consultation and prompt drainage by a ureteral stent or a percutaneous nephrostomy tube
True
If patients present with the below symptoms a referral to where is warranted?
- obstructing stone with signs of infection
- stone fails to pass within 4 weeks
- fever
- intolerable pain
- persistnet nausea and vomiting
Urology
