Renal calculi

Question 1

Definition

Answer 1

Renal calculi can obstruct the urinary tract

Question 2

What are the stones usually made of ?

Answer 2

Urine calcium salts

Question 3

Causes

Answer 3

Proteus organism

Question 4

3 most common locations

Answer 4

Ureteric orifice
Where ureter crosses over the anterior aspect of the common iliac artery
Pelviureteric junction

Question 5

Clinical features

Answer 5

Colicky pain (due to peristalsis)
Loin to groin pain
Frank haematuria

Question 6

Investigation aims

Answer 6

Identify calculus causing the symptoms
Assess the size and morphology of the calculus
Detect associated ureteric obstruction

Question 7

First line investigation

Answer 7

KUB X-ray

- filling defect (gap which suggests there is a kidney stone causing a blockage)

Question 8

If you can see the stone on the X-ray you still need to get a CT. True or false?

Answer 8

False

- want to minimise radiation exposure as much as possible

Question 9

If you CANT see the stone on the X-ray what is the next investigation?

Answer 9

CT scan

• definitive imaging
• stones show up clearly

Question 10

Management

Answer 10

NSAIDs +/- opiates
Alpha blocker
- may help small stones pass

Question 11

What happens if the stone hasn’t passed in 1 month?

Answer 11

Ureteric stent OR 
Stone fragmentation (cystolitholapexy)