Renal Calculi

Question 1

what is gross hematuria

Answer 1

blood in urine that is visible to the naked eye

Question 2

what is microscopic hematuria

Answer 2

RBCs in urine visible only with microscope

Question 3

what are risk factors for urologic malignancy

Answer 3

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

Question 4

what are glomeruluar causes

Answer 4

from kidney itself, nephrology referral

Question 5

what are non-glomeruluar causes

Answer 5

structural and pathologic conditions visible on imaging or endoscopic exam

Question 6

what are the microhematuria risk stratification categories

Answer 6

age, sex, smoking hx and RBCs in urinalysis

Question 7

what is the wrokup for gross hematuria

Answer 7

cystoscopy, cytology, imaging with CTU or MRU

Question 8

what is a CTU and MRU

Answer 8

CT urogram - multiphasic contrasted scan of A/P
MRI urogram

Question 9

what is renal calculi

Answer 9

kidney stones or nephrolithiasis

Question 10

what are risk factors for renal calculi

Answer 10

+ 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

Question 11

what medications can cause renal calculi

Answer 11

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

Question 12

when do kidney stones form

Answer 12

when urine is super-saturated
anything that increase urine concentration or impact solubility

Question 13

where are renal calculi most often found

Answer 13

ureterpelvic junction (UPJ)
near iliac artery
Ureterovesicular junction (UVJ)

Question 14

what are the four main types of kidney stones

Answer 14

calcium-based stones
uric acid stones
struvite stones
cystine stones

Question 15

what is the most common type of kidney stone

Answer 15

calcium-based stones

Question 16

what is struvit

Answer 16

magnesium ammonium phosphate

Question 17

what are struvite stones associated with

Answer 17

UTI

Question 18

what is the presentation of renal calculi

Answer 18

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

Question 19

What are PE findings of renal calculi

Answer 19

mostly normal
+ CVA tenderness biggest PE finding
+/- flank and or suprapubic tenderness
+/- hematuria
No comfortable position

Question 20

what are the PE findings of renal calculi if associated infection

Answer 20

fever, tachycardia, hypotension
septic stones are surgical emergency, require immediate ureteral stenting or PCN placement to drain infected urine trapped behind the stone

Question 21

when is renal calculi considered a surgical emergency

Answer 21

septic stones
uretral stenting or PCN placement to drain infected urine behind the stone

Question 22

what is the gold standard test for renal calculi

Answer 22

non-contrast CT

Question 23

what is a good first line imaging test for renal calculi

Answer 23

Renal US

Question 24

what is the pregnant for acute renal colic and not pregnant

Answer 24

conservative tx - hydration, pain control, anti-emetic
Metoclopramide only approved for renal colic and synergistic with pain meds

Question 25

what is the treatment of a confirmed stone < 10mm

Answer 25

consider ‘medical expulsive therapy’ or MET
alpha-blockers: tamsulosin, alfuzosin, silodosin

Question 26

at what size do stones usually pass on their own

Answer 26

< 5mm

Question 27

when is surgical management the treatment for renal calculi

Answer 27

confirmed stone > 10mm OR failed conservative management

Question 28

what is the first line surgical treatment for renal calculi

Answer 28

Extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy

Question 29

what are the general prevention management for renal calculi

Answer 29

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

Question 30

what is the prevention management for prevention of calcium stones

Answer 30

DONT limit calcium
thiazide diuretics to decrease urinary calcium

Question 31

what is the prevention management for prevention of uric acid stones

Answer 31

low purine diet
potassium citrate or sodium bicarb
allopurinol if gout or above fails