Renal stones Flashcards
What are kidney stones due to?
Precipitates that form from the urine due to high concentration in the urine
What is the main composition of renal stones
Calcium oxalate
What are other possible compositions of renal stones?
Calcium phosphate
Uric acid
What are possible risk factors of renal stones?
- Dehydration
- Hypercalciuria
- Hyperparathyroidism
- Hypercalcaemia
- Gout
What drugs increase the risk of renal stones?
Loop diuretics
Steroids
How do renal stones present?
- Colicky loin to groin pain
- Haematuria
- Nausea and vomiting
- Sepsis
- Dysuria
What is the main way renal stones are diagnosed?
Non-contrast CT-KUB
What other diagnostic methods are there fore renal stones?
- Urine dipstick and culture
* Bloods-infection and kidney function
What is the analgesic management of renal stones?
NASID’s
What NSAID’s can be used in the management of kidney stones/ renal colic?
Diclofenac-main
Ibuprofen
What are other forms of management for renal stones?
Extracorporeal shockwave lithotripsy
What can be used as prophylaxis against renal stones?
Thiazide
What is staghorn calculus?
Renal calculus forms in the shape of a staghorn
Where does a staghorn calculus form?
Body in pelvis, horn in renal calyx
What is a staghorn calculus composed of?
Struvite
What is a staghorn calculus associated with?
Proteus infection- proteus mirabilis
(Recurrent upper urinary tract infections)
What is struvite?
Ammonium magnesium sulphate
How is a staghorn calculus diagnosed?
X-ray
What is the main complication of diclofenac?
Increased risk of cardiovascular events
What is the management of Stones < 5 mm?
They normally pass spontaneously within 4 weeks of symptom onset
When would more urgent treatment be required for someone presenting with renal stones?
Ureteric obstruction
Renal developmental abnormality- horseshoe kidney
Previous renal transplant
What situation would be classed as a surgical emergency in someone presenting with renal stones?
Ureteric obstruction due to stones together with infection
What is the management of ureteric obstruction along with infection?
Decompression
Nephrostomy tube placement
Insertion of ureteric catheters
Ureteric ste
What would be the management of a stone burden of less than 2cm in aggregate?
Shockwave lithotripsy
What would be the management of a stone burden of less than 2cm in pregnant females?
Ureteroscopy
What would be the management of large (>2cm), complex renal calculi and staghorn calculi?
Percutaneous nephrolithotomy
What is the problem with NSAID’s such as diclofenac and ibruprophen?
Increased risk of cardiovascular events
What does
–acute-onset loin-to-groin pain
–Hypotension
–Temperature
suggest?
Obstructive urinary calculi
manage with urgent renal decompression and IV antibiotics due to the risk of sepsis
What are the different ways in which decompression can be achieved?
Percutaneous ureteroscopy or percutaneous nephrostomy
Why would you use uteroscopy in the management of pregnant females with renal stones?
Lithotripsy is contraindicated
