Renal Calculi Flashcards
Which medications can cause stones?
Vitamin A B and C, antacid, diuretic, calcium
What is the role of alpha-adrenergic receptor blockers in renal calculi?
Cause relaxation of smooth muscle in the ureters to facilitate stone passage and decrease pain
Who do you send home and who do you treat?
Home: painfree after 3 hours
Not: If febrile
If only one kidney or if both kidneys are obstructed
If the pain doesn’t settle
What are some good options for home analgesic management of renal colic?
Endocet suppository
Endone
How are cysteine stones treated?
Increase urine pH
Fluids
penicillamine
What are the most useful biochemical Ix for stones?
Stone biochemistry
24 urine Ca
How long do you give someone to pass their stone?
3-6 weeks
Is US valuable for the diagnosis of renal calculi?
No
How does a person with renal colic appear on observation and examination?
Restless
Non tender at the site of pain
No peritonism
When is lithotripsy indicated?
When the stone isn’t too large and in the renal pelvis
What type of xray is used for investigation of renal calculi? Why is it indicated?
XrayKUB
To avoid having to do another CT to follow up
Does the location of pain reflect the location of the stone?
No
How do you dissolve uric acid stones?
Increase urine pH with bicarb
Flush with water
Allopurinol
What are some treatment option for stones?
Conversative management
Dissolve
Destroy - US
Stent
Which stones form in acidic conditions? And which form in basic conditions?
Acidic :Uric acid
Cysteine
Basic: Calcium phosphate
Struvite
What is stemitil?
Prochlorperazine
Which type of diuretic causes hypercalcaemia?
Thiazide
Which stones are radiolucent?
Uric acid
Cystine
What is a phlebolith?
Calcification of a venous valve
- can complicate diagnosis
What is the typical medical regimen for acute management of renal colic?
10mg morphine (or 100mg pethadine)
10mg metaclopramide
What is the best investigation for stones?
Non-contrast CTKUB
What is the character of renal colic?
Colicky/constant
Flank/groin
How do you investigate the formation of stones?
Water consumption
Gout
Other conditions that cause it
FHx
What percentage of renal colic has haematuria?
90%
Which stones will pass?
If the diameter is <4mm
How is calcium intake related to stone formation?
Inversely
How do you advise people on how much water to drink?
Drink until your urine is light yellow
What are treatment options for large stones?
Ureteroscopy and disintegration with laser mainly
How are some types of stones?
Calcium oxalate
Calcium phosphate
Uric acid
Cysteine stones
Struvite
What are some lifestyle and medical modifications that can be made?
Remove source
3L urine output per day
Low Na input
Low animal protein
Thiazide
Allopurinol
What are some DDx for flank pain?
Appendicitis
Testicular torsion
Biliary colic
Ovarian cyst
Diverticulitis
What type of stones can be dissolved medically?
Uric acid
