Renal colic

Question 1

What is renal colic caused by?

Answer 1

Kidney stones

Question 2

How do kidney stones form?

Answer 2

Crystals in supersaturated urine

Hypercalcuria = calcium oxalate stones**

Can have calcium phosphate

Uric acid

Infection induced stones

Cysteine stones

Question 3

What is the pathophysiology?

Answer 3

Stones form = get stuck in ureter = hydronephrosis = kidney damage

Question 4

Where are the common sites of obstruction?

Answer 4

• Uretopelvic junction

- Vesicoureteric junction

Question 5

What is a phlebolith?

Answer 5

Calcification of a valve (vein) in the pelvis

Can mimic a stone

Question 6

What causes hypercalcuria?

Answer 6

Hyperparathyroidism = increases PTH = increase Ca resorption

XS dietary intakeof Ca

Idiopathic

Question 7

What causes hyperoxaluria?

Answer 7

Diet - spinach, rhubarb, choc, tea

Question 8

How does it present?

Answer 8

Unilateral colicky loin pain 
Radiates to vulva/clitoris or tip of penis 
N/V
Haematuria 
Sepsis 
Fever >38
Dysuria 
Low BP - septic shock

Question 9

What IX do you do?

Answer 9

Urinalysis - dipstick (normal +/- haematuria)

MSU for microscopy + culture

FBC/CRP - infection

Calcium/urate - underlying cause

NCCT KUB**

US - hydronephrosis

KUBXR

Do clotting - if percutaneous intervention planned

Question 10

How are renal stones MX?

Answer 10

NSAID - diclofenac (CVD risk)

Stones <5mm will usually pass spontaneously = MX expenctantly

Minimally invasive options are 1st line

Stones <2cm in aggregate = lithotripsy

Stones <2cm in pregnancy = ureteroscopy

Complex renal calculi and staghorn calculi = percutaneous nephrolithotomy

Question 11

How is it MX in an emergency situation?

Answer 11

If there is ureteric obstruction, renal developmental abnormality or previous renal transplant

Ureteric obstruction due to stones together with infection is surgical emergency

• NEPHROSTOMY TUBE PLACEMENT
• INSERTION OF URETERIC CATHETERS
• URETERIC STENT PLACEMENT