Renal colic

Question 1

Describe renal colic pain

Answer 1

Pain due to kidney stones

1. Rapid onset (patients wake from sleep)
2. ‘Loin to groin’ intense pain (writhing in pain)
3. Comes in waves 20-60min
4. Associated with vomiting and nausea
5. Worse with fluid loading

Question 2

Epidemiology of urolithiases

Answer 2

1. 3x more likely in men

2. 50% risk of recurrence

Question 3

RF urolithiases

Answer 3

1. Dehydration
2. Obesity
3. FHx/PMH
4. Diet high in components of stones (calcium, salt)
5. Gastric bypass surgery (increases calcium absorption)
6. Hyperparathyroidism
7. HTN
8. Gout
9. Immobilisation (bone resorption)
10. UTIs

Question 4

Common sites of urolithiases

Answer 4

1. Pelvi-ureteric junction
2. Pelvic brim
3. Vesico-ureteric junction

Question 5

Compositions of stones

Answer 5

1. Calcium oxalate
2. Struvite
3. Urea
4. Cystine

Question 6

Signs and symptoms of urolithiases

Answer 6

1. Asymptomatic - chance finding on CT/XR
2. Renal colic
3. UTI symptoms - urgency, haematuria, cloudy/foul smelling urine, pain on urination, change in urine habit, fever + chills

Question 7

Diagnosis of urolithiases

Answer 7

1. Bloods - FBC, uric acid, calcium, phosphate
2. Urinalysis
3. NCCT-KUB (non contrast CT - kidneys, ureter, bladder) - GOLD STANDARD
4. KUB-XR - first line

Question 8

Management of urolithiases

Answer 8

1. Analgesics - NSAIDs
2. Antiemetics
3. Antibiotic + drain if UTI
4. If <5mm 90% pass
5. If >5mm: nifedipine (CCB) or tamsulosin (a-blocker) - promote expulsion and pain relief
   - Extracorporeal shockwave lithotripsy - sound waves break up stone
   - Percutaneous nephrolithotomy - keyhole

Question 9

Prevention of urolithiases

Answer 9

1. Reduce BMI
2. Low salt, oxalate, calcium diet
3. Stay hydrated

Question 10

Differential diagnosis

Answer 10

1. AAA
2. Diverticulitis/appendicitis
3. Pyelonephritis
4. Testicular torsion
5. Acute pancreatitis