Renal Lethiasis

Question 1

Are male or females more likely to have kidney stones?

The rate of kidney stone development increases with what variable?

Answer 1

males (2:1)

rate increases with age

Question 2

What are the 4 considerations you need to think of when deciding the course of action in treating a kidney stone?

Answer 2

1. Severity & type of stone
2. Whether first or recurrent stone
3. Presence/Absence systemic disease and/or risk factors for recurrent stone formation
4. Family histor of nephrolithiasis (kidney stones)

Question 3

Describe the classic clinical presentation for kidney stones

Answer 3

• Can be asymptomatic
• Symptomatic
  
  • Renal colic (waxing & waning pain that occurs as the stone is moving down the ureter towards the bladder)
  • hematuria
  • vague abdominla pain
  • testicular pain
  • urinary frequency & urgency (as it is traveling down the ureter, stimulates the feeling of having to urinate)
  • dysuria
  • passage of gravel or a stone

Question 4

Where do kidney stones develop & when do they become symptomatic?

What are the symptoms?

Answer 4

Grow on renal papillae or within collecting system where they do not cause symptoms

• Become symptomatic when they pass into the ureter or occlude the uretopelvic junction
  
  • ​flank pain - spreads toward groin, testis, or vulva
  • cause hematuria
  • most smaller than 5mm will pass spontaneously

Question 5

What are the 6 major risk factors for renal nephrolithiasis?

Answer 5

1. History of prior nephrolithiasis
   
   • about one stone per decade
2. Family history (>2x)
3. Enhanced enteric oxalate absorption
   
   1. gastric bypass, short bowel syndrome
4. Frequent upper urinary tract infections
   
   1. struvite stones in UTIs with urease producing organisms (proteus and klebsiella)
5. Hypertension (2x)
6. Persistently acidic urine promotes uric acid precipitation

Question 6

What are the 4 different types of kideny stones?

Answer 6

Patient may have more than one type of stone at the same time

• Calcium salts (75-85% all stones)
  
  • calcium oxalate- (more common)
  • calcium phosphate
    
    • hydroxyapatite (more common) & brushite
• Uric acid
• Cystine
• Struvite (MgNH₄PO₄)