Renal Calculi Flashcards
What should immediatly be thought of if someone has painless gross hematuria
bladder cancer until proven otherwise
What is the most common cause of gross hematuria
BPH
If a dipstick is positive for heme and 2+protein, where is the most likely issue
Kidneys
What does it mean if the dipstick is positive for epithelial cells
Contaminated specimen
What is the difference between glomerular and non-glomerular etiologies
Glomerular: kidney itself
Non- Glomerular: Structural/pathologic condition wisinle on imaging
What RBC amount is the qualifying level for a hematuria
over 3
What imaging is preformed with gross hematuria
Cystoscopy
CTU/MRU
What type of eval/imaging is preformed with intermediate/highrisk hematuria
cystoscopy
cytology not routinely recom.
no role for ultrasound
What is the third most common urinary tract disease
nephrolithiasis
How do kidney stones form
background causes?
Supersaturation of urine
Dehydration, decreased UPO, increased excretion, disturbance in pH
What is the biggest contributing risk factor for kidney stones
Dehydration
Where are kidney stones most commonly found
ureteropelvic junction near the iliac artery OR at the ureterovesicular junction
What are the 4 main types of kidney stones
Calcium based
uric acid
struvite
cystine
What is the most common type of kidney stones
What are the types within this class
Calcium
Calcium oxalate & calcium phosphate
What are the traditional risk factors for calcium stones
dehydration
obesity
GI issues
Diuretics
dietary oxalate (rhubarb / spinach)
What are the causes of uric acid stones
Risk factors?
Causes?
Monosodium urate, associated with gout and DM
+ family history
fish, shellfish, meat
What is struvite
When do these stone occur
What are the characteristics
Magnesium ammonium phosphate
Post UTI typically
fast growing, become staghorn
When are cystine stones typically seen
cause?
younger… under 40 y/o
inherited metabolic disorder (cystinuria)
What is the presentation of renal calculi
flank pain (CVA radiating to groin)
inability to get comfortable
N/V
Dysuria
inability to urinate
cloudy/foul smelling urine
hematuria
What is the biggest PE finding with renal calculi
CVA tenderness
If the renal calculi are associated with infection, what interventions need to be done
immediate ureteral stenting
PCN placement
What is the gold standard imaging test for renal calculi
first line imaging for stones?
non-con CT
Renal US
What size stones can generally pass on their own
What size stone is considered for medical expulsive therapy (MET)
<5mm
<10mm
If a patient has renal colic and is not pregnant, what is the only approved medication that can be used
What is the standard tx for renal colic
Metoclopramide
Hydration, pain control, anti-emetic
