Renal Colic

Question 1

DDx for renal colilc.

Answer 1

Renal

• lower urinary tract infection
• pyelonephritis
• acute renal infarction

Gynae

• ectopic rupture
• ovarian rupture
• endometriosis
• PID
• GI causes of pain
• MSK causes of pain

Question 2

What collection of symptoms would make you think it was likely renal colic?

Answer 2

• abrupt onset unilateral loin to groin pain
• spasmodic with periods of no pain
• writhing, difficulty getting comfortable
• super bad pain - worse than labour - 12/10
• associated N&V
• radiates to labia or testicle

Question 3

What are some risk factors for developing renal stones?

Answer 3

• dehydration
• loop diuretics
• gout Pmhx
• hypercalcaemia, hyperparathyroidism, hypercalcuria
• PKD
• renal tubular acidosis
• contrast exposure

-ileostomy - loss of bicard = increased urine acidity

Question 4

What initial investigations do you need to do for renal colic?

Answer 4

• urine dip + MCS - infection tings + pregnancy ting

- bloods - FBC, U&E (renal function), clotting (for intervention), calcium + urate

Question 5

If history or initial tests suggest kidney stones what imaging would you do in what time frame?

Answer 5

• Non-contrast KUB CT scan within 14hrs if no risk factors

- immediate KUB CT if 1 kidney, fever or uncertain diagnosis

Question 6

What is the analgesia for choice in severe renal colic?

Answer 6

• IM diclofenac

- NSAIDS are good but consider cardiovascular risk

Question 7

What is the management for an acute renal colic?

Answer 7

• admit & observe
• Fluids
• NSAIDS + opiates + antiemetic

Question 8

A patient with renal colic is admitted and 6 hours later develops rigours and a fever. Why is this worrying? What management should ensure?

Answer 8

• infection + obstruction you can lose kidney function w/in 24 hours
• THEY CAN KILL -sepsis
• IV Abx, IVI, Oxygen
• drainage + escalate

Question 9

What methods of drainage for kidney stones are there?

Answer 9

• uteric stent

- nephrostomy

Question 10

What types of renal stones are there?

Answer 10

Calcium Oxalate (80%) - hypercalciuria things
Urate/uric acid (10%) - gouty diet things + high turnover of cells
struvite (5%) - UTI stones
Mixed (5%)

Question 11

How can you provide prophylaxis for some kidney stones?

Answer 11

-urine alkalinization - increased dietary fruit or IV bicarb in poisoning situ

Question 12

Treatment for kidney stones.

Answer 12

• hydrate
• pain relief
• alpha blocker - tamsulosin - increases ureter width and motility to encourage passage
• shockwave lithotripsy
• uterorenoscopy - endoscope em out

Question 13

Stone type specific treatment. Calcium? Urate? Struvite?

Answer 13

calcium - thiazide diuretic
Urate - allopurinol
struvite - ABX for UTI

Question 14

What is the cut off measurement for a kidney stone to be deemed for expectant management?

Answer 14

5mm or less is to be managed expectantly