Renal Colic - Nephrolithiasis Flashcards
What is renal colic? and what is MC type
Acute severe loin pain consequence of a urinary stone obstructing urinary flow and cauasing urine build up
MC- Calcium oxalate stone
What are the RF for renal colic
Modifiable RF
Chronic dehydration
High Meat intake
increased BMI
High salt intake
Non-modifiable RF
PKD
HyperPTH
Multiple myeloma
UTI
Crohns disease
Men>Women (testosterone~oxalate)
Name different types of renal stones?
Calcium oxalate
Struvite (MG,Phosphate,Ammonium)~ UTI
Uric Acid ~ Gout, chemo
Cystine stone
How can a UTI increase % of a renal stone and how can a renal stone increase % of a UTI
Renal stone = obstruction = urinary stasis = % BACTERIAL INVASION
UTI = urease-producing microorganisms including Proteus and Klebsiella convert urea to ammonia = ammonia supersaturation =% of struvite stone
What is the pathophysiology underlying renal colic?
Obstruction of urinary flow = causes prostaglandin release
Prostaglandin => Vasodilation and urethral smooth muscle wall spasms (urethral peristalsis)
vasodilation promotes diuresis = Increases renal presure and distends renal capsule => Intense loin to groin pain (20-60min)
Sx relief once fixed
Clinical features of Renal colic?
Loin to groin pain - Colicky manner w/ waves of sever pain
N/V
Urine: Dysuria Urgency frequency
Signs
Haematuria
Flank tenderness
fever
Rigor
+/- signs of UTI - check for septic
Complication of renal colic
Urosepsis
Renal colic Dx
KUB XR - Calcium is radiopaque, other are radiolucent
Diagnostic : Non-contrast computed tomography (CT) scan
CT KUB
CI KIDS / PREGGO - Ultrasound
Renal Colic TX
The larger the stone and more proximal it is the more intervention
1st - Analgesia NSAIDS / PARACETAMOL and Hydration
<5mm stone - passes spontaneously
>5mm stone - Shockwave lithotripsy or PCNL
2nd line- Ureteroscopy
what is PCNL
Percutaneous nephrolithotomy
a nephoscopy is passed into the collecting system and used to break up stones.
