Renal Calculi

Question 1

Where in the urinary tract are renal calculi most likely to be found?

Answer 1

Pelvi-ureteric junction or vesico-ureteric junction

Question 2

What is the typical demographic of individual to be affected by a renal calculi?

Answer 2

Males, aged 20-40

Question 3

What is the most common type of renal calculi?

Answer 3

Calcium oxalate

Question 4

Which two types of renal calculi are not radio-opaque?

Answer 4

Uric acid and cysteine stones

Question 5

Which type of renal calculi can be associated with chemotherapy?

Answer 5

Uric acid stones

Question 6

Which type of renal calculi is often associated with a family history of stones, since they are caused by an inherited metabolic disease?

Answer 6

Cysteine stones

Question 7

Proteus infection is a recognised cause of the formation of which type of renal calculi?

Answer 7

Struvite (triple phosphate) stones

Question 8

Which type of renal calculi is responsible for the formation of a staghorn calculus?

Answer 8

Struvite (triple phosphate) stones

Question 9

Other than being asymptomatic, what are some ways that a renal calculi can present?

Answer 9

Renal colic, haematuria, UTI, obstruction

Question 10

Describe the pain of renal colic?

Answer 10

Colicky, loin to groin pain

Question 11

Describe how a patient with renal colic will typically behave?

Answer 11

They will be restless

Question 12

What is an important non-renal differential diagnosis of renal colic that is important to consider?

Answer 12

AAA

Question 13

What are the most important blood tests to perform in someone with a suspected renal calculi?

Answer 13

U&Es and calcium

Question 14

What is the most common feature seen on urinalysis of someone with renal calculi?

Answer 14

Haematuria

Question 15

What 3 bedside tests should be performed on someone with suspected renal calculi?

Answer 15

Bloods, urinalysis, urine microscopy and culture

Question 16

What is the first line investigation for someone with suspected renal calculi?

Answer 16

KUB-radiograph

Question 17

What is the gold standard, definitive investigation for someone with suspected renal calculi?

Answer 17

CT-KUB

Question 18

Most renal calculi with a diameter of less than what will pass spontaneously without surgery?

Answer 18

< 5mm

Question 19

What initial conservative management is required for all patients with renal calculi?

Answer 19

Maintenance of adequate hydration and analgesia

Question 20

When is urgent intervention required for a patient with renal calculi?

Answer 20

If there is evidence of infection or renal failure

Question 21

Large stones > 5mm which lie in the lower ureter and fail to pass spontaneously can be treated with what?

Answer 21

Extracorporeal shock-wave lithotripsy (ESWL)

Question 22

What is the most appropriate analgesia to give to someone with a renal calculi if there are no contra-indications?

Answer 22

75mg diclofenac IM or IV

Question 23

When should opiate analgesia be used in the management of renal calculi?

Answer 23

If there are contraindications to the use of NSAIDs

Question 24

What medications can be used for medical expulsive therapy of distal ureteric stones which are < 10mm?

Answer 24

Tamsulosin or nifedipine

Question 25

Extracorporeal shock-wave lithotripsy can only be used to break up stones which are less than what diameter?

Answer 25

< 1cm

Question 26

What surgery is used to treat large renal calculi present in the renal pelvis or upper ureter?

Answer 26

Percutaneous nephrolithotomy

Question 27

What are some indications for the use of percutaneous nephrolithotomy as a treatment for renal calculi?

Answer 27

If the calculi is > 3cm in diameter or is a staghorn calculus

Question 28

Renal calculi regularly cause obstruction of the urinary tract which leads to what complication?

Answer 28

Hydronephrosis

Question 29

Loin pain, swinging pyrexia and dysuria may suggest the presence of what complication of renal calculi?

Answer 29

Obstructed infected kidney

Question 30

What is the treatment for an obstructed infected kidney?

Answer 30

Percutaneous nephrostomy

Question 31

What is some general advice that can be given to patients to prevent future renal calculi?

Answer 31

Drink lots of fluids and maintain a normal dietary calcium intake

Question 32

What medication can be used to prevent the formation of renal calculi containing calcium?

Answer 32

Thiazide diuretics

Question 33

What medication can be used to prevent the formation of renal calculi containing uric acid?

Answer 33

Allopurinol

Question 34

Bladder calculi are a completely distinct entity from ureteric and renal calculi. They are usually caused by what?

Answer 34

Urinary stasis associated with a bladder outlet obstruction

Question 35

Longstanding untreated bladder calculi are associated with what complication?

Answer 35

Squamous cell carcinoma of the bladder

Question 36

Most bladder calculi are asymptomatic. However, if they do cause symptoms, what might these be?

Answer 36

Suprapubic pain, dysuria, haematuria

Question 37

What two investigations are best for identifying the presence of bladder calculi?

Answer 37

KUB-radiograph and cystoscopy

Question 38

How are bladder calculi usually treated?

Answer 38

Interventional cystoscopy (cystolitholapaxy)