Renal Calculi Flashcards
Where in the urinary tract are renal calculi most likely to be found?
Pelvi-ureteric junction or vesico-ureteric junction
What is the typical demographic of individual to be affected by a renal calculi?
Males, aged 20-40
What is the most common type of renal calculi?
Calcium oxalate
Which two types of renal calculi are not radio-opaque?
Uric acid and cysteine stones
Which type of renal calculi can be associated with chemotherapy?
Uric acid stones
Which type of renal calculi is often associated with a family history of stones, since they are caused by an inherited metabolic disease?
Cysteine stones
Proteus infection is a recognised cause of the formation of which type of renal calculi?
Struvite (triple phosphate) stones
Which type of renal calculi is responsible for the formation of a staghorn calculus?
Struvite (triple phosphate) stones
Other than being asymptomatic, what are some ways that a renal calculi can present?
Renal colic, haematuria, UTI, obstruction
Describe the pain of renal colic?
Colicky, loin to groin pain
Describe how a patient with renal colic will typically behave?
They will be restless
What is an important non-renal differential diagnosis of renal colic that is important to consider?
AAA
What are the most important blood tests to perform in someone with a suspected renal calculi?
U&Es and calcium
What is the most common feature seen on urinalysis of someone with renal calculi?
Haematuria
What 3 bedside tests should be performed on someone with suspected renal calculi?
Bloods, urinalysis, urine microscopy and culture
What is the first line investigation for someone with suspected renal calculi?
KUB-radiograph
What is the gold standard, definitive investigation for someone with suspected renal calculi?
CT-KUB
Most renal calculi with a diameter of less than what will pass spontaneously without surgery?
< 5mm
What initial conservative management is required for all patients with renal calculi?
Maintenance of adequate hydration and analgesia
When is urgent intervention required for a patient with renal calculi?
If there is evidence of infection or renal failure
Large stones > 5mm which lie in the lower ureter and fail to pass spontaneously can be treated with what?
Extracorporeal shock-wave lithotripsy (ESWL)
What is the most appropriate analgesia to give to someone with a renal calculi if there are no contra-indications?
75mg diclofenac IM or IV
When should opiate analgesia be used in the management of renal calculi?
If there are contraindications to the use of NSAIDs
What medications can be used for medical expulsive therapy of distal ureteric stones which are < 10mm?
Tamsulosin or nifedipine
Extracorporeal shock-wave lithotripsy can only be used to break up stones which are less than what diameter?
< 1cm
What surgery is used to treat large renal calculi present in the renal pelvis or upper ureter?
Percutaneous nephrolithotomy
What are some indications for the use of percutaneous nephrolithotomy as a treatment for renal calculi?
If the calculi is > 3cm in diameter or is a staghorn calculus
Renal calculi regularly cause obstruction of the urinary tract which leads to what complication?
Hydronephrosis
Loin pain, swinging pyrexia and dysuria may suggest the presence of what complication of renal calculi?
Obstructed infected kidney
What is the treatment for an obstructed infected kidney?
Percutaneous nephrostomy
What is some general advice that can be given to patients to prevent future renal calculi?
Drink lots of fluids and maintain a normal dietary calcium intake
What medication can be used to prevent the formation of renal calculi containing calcium?
Thiazide diuretics
What medication can be used to prevent the formation of renal calculi containing uric acid?
Allopurinol
Bladder calculi are a completely distinct entity from ureteric and renal calculi. They are usually caused by what?
Urinary stasis associated with a bladder outlet obstruction
Longstanding untreated bladder calculi are associated with what complication?
Squamous cell carcinoma of the bladder
Most bladder calculi are asymptomatic. However, if they do cause symptoms, what might these be?
Suprapubic pain, dysuria, haematuria
What two investigations are best for identifying the presence of bladder calculi?
KUB-radiograph and cystoscopy
How are bladder calculi usually treated?
Interventional cystoscopy (cystolitholapaxy)
