Renal Calculi Flashcards
what is gross hematuria
blood in urine that is visible to the naked eye
what is microscopic hematuria
RBCs in urine visible only with microscope
what are risk factors for urologic malignancy
older age
male gender
hx of smoking
hx of occupational chemical benzene or aromatic amines exposure
other environment exposures
hx of cyclophosphamids/ifosfamide therapy or pelvic radiation
irritative voiding symptoms (chronic inflam)
hx of chronic indwelling catheters (chronic inflam)
+fhx of urothelial cancers
what are glomeruluar causes
from kidney itself, nephrology referral
what are non-glomeruluar causes
structural and pathologic conditions visible on imaging or endoscopic exam
what are the microhematuria risk stratification categories
age, sex, smoking hx and RBCs in urinalysis
what is the wrokup for gross hematuria
cystoscopy, cytology, imaging with CTU or MRU
what is a CTU and MRU
CT urogram - multiphasic contrasted scan of A/P
MRI urogram
what is renal calculi
kidney stones or nephrolithiasis
what are risk factors for renal calculi
+ fx or personal hx of kidney stones
dehydration
distal RTA (renal tubule acidosis)
medullary kidney disease
GI malabsorptions
Gout
hypercalciuria/hyperuricosuria
primary Hyperparathyroidism
obesity
HTN
NIDDM
recurrent UTI
what medications can cause renal calculi
Diuretics
topiramate
acetazolamide
pred
protease inhibitors(HIV)
probenecid (gout med)
decongestants
calcium-containing antacids
laxatives (abuse)
*diets high in animal proteins, oxalates, sodium, sucrose, fructose
when do kidney stones form
when urine is super-saturated
anything that increase urine concentration or impact solubility
where are renal calculi most often found
ureterpelvic junction (UPJ)
near iliac artery
Ureterovesicular junction (UVJ)
what are the four main types of kidney stones
calcium-based stones
uric acid stones
struvite stones
cystine stones
what is the most common type of kidney stone
calcium-based stones
what is struvit
magnesium ammonium phosphate
what are struvite stones associated with
UTI
what is the presentation of renal calculi
Flank pain
inability to get comfortable
N/V
dysuria
inability to urinate
increased urgency and frequency
cloudy or foul-smelling urine (if infected)
hematuria (90%)
+/- fever/chills
What are PE findings of renal calculi
mostly normal
+ CVA tenderness biggest PE finding
+/- flank and or suprapubic tenderness
+/- hematuria
No comfortable position
what are the PE findings of renal calculi if associated infection
fever, tachycardia, hypotension
septic stones are surgical emergency, require immediate ureteral stenting or PCN placement to drain infected urine trapped behind the stone
when is renal calculi considered a surgical emergency
septic stones
uretral stenting or PCN placement to drain infected urine behind the stone
what is the gold standard test for renal calculi
non-contrast CT
what is a good first line imaging test for renal calculi
Renal US
what is the pregnant for acute renal colic and not pregnant
conservative tx - hydration, pain control, anti-emetic
Metoclopramide only approved for renal colic and synergistic with pain meds
what is the treatment of a confirmed stone < 10mm
consider ‘medical expulsive therapy’ or MET
alpha-blockers: tamsulosin, alfuzosin, silodosin
at what size do stones usually pass on their own
< 5mm
when is surgical management the treatment for renal calculi
confirmed stone > 10mm OR failed conservative management
what is the first line surgical treatment for renal calculi
Extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy
what are the general prevention management for renal calculi
increase fluid intake
sodium intake < 3500 mg/day
avoid large intakes of animal protein
? role for regular r/u and yearly US to assess efficacy
what is the prevention management for prevention of calcium stones
DONT limit calcium
thiazide diuretics to decrease urinary calcium
what is the prevention management for prevention of uric acid stones
low purine diet
potassium citrate or sodium bicarb
allopurinol if gout or above fails
