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Renal > Renal Colic - Kidney stones > Flashcards

Renal Colic - Kidney stones Flashcards

1
Q

Renal stones can be referred to as …

A

Renal caliculi
Urolithiasis
Nephrolithiasis
Kidney Stones

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2
Q

What are kidney stones

A

hard stones that sit in the renal pelvis where the urine collects before travelling down to the ureters

Stones form in collecting ducts

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3
Q

Most common site that stones would get stuck

A

Vesico - ureteric junction

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4
Q

Two key complications of stones

A

Obstruction- leading to AKI
Infection- with obstructive pyelonephritis

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5
Q

Most common type of kidney stone and its subgrouops

A

CALCIUM BASED STONES

Calcium oxalate - 80-85
Calcium Phosphate

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6
Q

major risk factors for stones

A

Hypercalcaemia
Low urine output
Dehydration

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7
Q

Other types of kidney stones

A

Uric acid- not visible on x ray
Struvite- produced by bacteria
Cystine- associated with cystinuria

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8
Q

What is a staghorn calculus

A

where the stone forms in the shape of the renal pelvis,

The body sits in the renal pelvis with horns extending into the renal calyces.

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9
Q

Presentation of stones

A
  • RENAL COLIC
  • unilateral loin to groin pain ‘ patient cant lie still’
  • Colicky as the stone moves and settles
    -Luts
    -Haematuria
  • dysuria
  • fever
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10
Q

Other signs and symptoms of kidney stones

A

Haematuria
Nausea or vomiting
Reduced urine output
Symptoms of sepsis, if infection is present

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11
Q

Investigations for renal colic

A
  • Urine dipstick- will show haematuria
  • Blood tests - elevated wbc may indicate infection
  • Abdo x ray- can show calcium based stones
  • Non contrast CT of kidneys, ureters and bladder within 24 hrs
  • 1st line KUB XRAY
  • GS: Non-Contrast Computerized Tomography Scan of the kidneys, ureter, and bladder
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12
Q

Presentation of hypercalcaemia ?

A

“renal stones, painful bones, abdominal groans and psychiatric moans”.

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13
Q

The three main causes of hypercalcaemia

A

calcium supplementation, hyperparathyroidism and cancer

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14
Q

Management of Kidney stones

A

NSAID’s
Antiemetics for N AND V
Antibiotics if infection
Tamsulosin to aid in spontaneous passage of stones

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15
Q

What are the surgical interventions for kidney stones ?

A

Extracorporeal shock wave lithotripsy : generates shock waves and directs them at the stone under x ray guidance

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16
Q

Dietary recommendations for calcium and uric acid stones

A

Calcium- reduce intake of oxalate- rich , spinach, beetroot, nuts, rhubarb

Uric acid stones - reduce intake of purine rich foods, kidney, liver anchioves sardines and spinach

17
Q

Pathophysiology of kidney stones

A

Excess solute in CD– Supersaturated urine – favors crystallisation- causes kidney damage

18
Q

Common Obstruction sites

A

Pelvic URETERIC JUNCTION
Pelvic brim
Vesoureteric junction

19
Q

RF for stones

A

Chronic Dehydration
Polycystic kidney disease
HyperPTH
UTI’s

20
Q

How is urine formed

A

Glomerular filtration - blood is filtered here, blood is filtered in such a way that all the constituents of the plasma reach the bowmans capsule

Reabsorption- via active and passive transport

21
Q

Differential diagnoses of renal colic

A
  • ruptured abdominal aortic aneurysm
  • appendicitis
  • ectopic pregnancy
  • ovarian cysts
  • bowel obstruction
22
Q

What would urea and electrolytes show for renal colic

A

Raised creatinine suggesting AKI

23
Q

What is the treatment of stones < 5mm in the lower ureter

A

90-95% pass spontaneously , increase fluid

24
Q

Treatment for other kidney stones

A

Symptomatic relief - hyrdation, NSAIDs (IV Diclofenac for extreme pain)

Decrease sodium and protein intake

25
Q

Mechanism of stone formation

A

Nucleation theory

26
Q

What is the nucleation theory?

A

suggest that stones form from crystals in supersaturated urine

As Concentration product of ions (e.g. Ca and Oxalate) go up it reaches Ksp the solubility point and goes up from there to Kfp - formation point

27
Q

History taking pneumonic

A

SOCRATES

28
Q

What does socrates stand for

A

S = site
O = onset
C = character
R = radiation
A = associated features
T = timing
E = exacerbating / relieving factors
S = severity

29
Q

Pros and cons Non-contrast Computerised Tomography – Kidneys, Ureter, Bladder

A

Very rapid (one breath hold)
99+% sensitive for stones Specificity ~90%
No contrast (allergies, renal function)
Other pathology/organs

But:
No functional info
Radiation (18/12 background, ~3.3mSv)

30
Q

Guide to interpreting NCCT

A

1) Count the kidneys
2) Condition of kidneys:
Perinephric tissues
Cortical thickness
Hydronephrosis +/- hydroureter
Stones
3) Other pathology?

31
Q

What can large kidney stones do?

A
  • Larger stones occlude calyces and/or Pelvi-ureteric junction
  • Can acutely obstruct – renal or ureteric colic
  • Chronic renal damage (esp. if infection stone)
    -abscess
    -fistulae
    -XPN (xanthogranulomatous pyelonephritis)

Renal (15 decks)

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