RENAL CALCULI

Question 1

Is kidney stones disease more common in males or females?

Answer 1

Males

Question 2

What are the different types of kidney stone that can form?

Answer 2

Calcium containing stones
Uric acid stones
Struvite or infection stones
Cysteine stones

Question 3

What is the most common type of renal stone?

Answer 3

Calcium oxalate stones

Question 4

What are the causes kidney stones?

Answer 4

Hypercalciuria (hypercalcaemia)
Hyperuricosuria (hyperuricaemia)
Hyperoxaluria - excess urinary excretion of oxalate
Cystinuria
Infection
Renal tubular acidosis
Polycystic kidney disease
Dehydration

Question 5

What are the symptoms of kidney stones?

Answer 5

Colicky pain
One quadrant of abdomen
Radiating from loin to groin

Sweaty
Pale
Restless
Nausea
Vomiting
Haematuria
Urinary urgency

Question 6

What are important things to look for in the history of someone presenting with kidney stone?

Answer 6

Diet (high calcium, high salt)
Fluid intake
Chronic diarrhoea - Crohn's disease
Gout
Family history of stones
Number of previous UTIs
Medications - antacid therapy, long term antibiotic therapy
Past urological history

Question 7

What might you look for during an examination of someone who presents with symptoms consistent with kidney stones?

Answer 7

Evidence of gout
Evidence of dehydration
Signs of infection

Question 8

What investigations might you carry out in someone with suspected renal stones?

Answer 8

Blood tests - look for hypercalcaemia and underlying cause
Urinalysis - identify and quantify amount of calcium, oxalate, urate or cysteine.
Stone analysis - ask patient to retain voided stones for analysis
Imaging - CT and MRI is now first line although KUB radiograph and ultrasound also used.

Question 9

What colour are calcium oxalate kidney stones?

Answer 9

Black / Dark brown

Question 10

What urine conditions lead to increased likelihood of developing calcium oxalate kidney stones?

Answer 10

Acidic urine

Question 11

What colour are calcium phosphate kidney stones?

Answer 11

Dirty white

Question 12

What urine conditions lead to increased likelihood of developing calcium phosphate kidney stones?

Answer 12

Alkaline urine

Question 13

What colour are uric acid kidney stones?

Answer 13

Yellow / reddish brown

Question 14

What urine conditions lead to increased likelihood of developing uric acid kidney stones?

Answer 14

Prolonged acidic

Question 15

What colour are struvite kidney stones associated with infections?

Answer 15

Dirty white

Question 16

How do you treat someone with kidney stones?

Answer 16

Analgesia
Increased fluid intake

Antibiotics if infection suspected
Allopurinol for uric acid based stones

Question 17

What drug can be used to decrease hypercalcuria in someone with recurrent calcium based renal stones?

Answer 17

Thiazide diuretics

Question 18

What is the endogenous chelating agent that can also be used to treat and prevent kidney stones?

Answer 18

Citrate

Question 19

What is kidney stone expulsion therapy?

Answer 19

Use of medications to speed the spontaneous passage of ureteral calculi. Several agents, including alpha adrenergic blockers (such as tamsulosin) and calcium channel blockers (such as nifedipine), have been found to be effective.