Renal stones

Question 1

What are kidney stones due to?

Answer 1

Precipitates that form from the urine due to high concentration in the urine

Question 2

What is the main composition of renal stones

Answer 2

Calcium oxalate

Question 3

What are other possible compositions of renal stones?

Answer 3

Calcium phosphate

Uric acid

Question 4

What are possible risk factors of renal stones?

Answer 4

• Dehydration
• Hypercalciuria
• Hyperparathyroidism
• Hypercalcaemia
• Gout

Question 5

What drugs increase the risk of renal stones?

Answer 5

Loop diuretics

Steroids

Question 6

How do renal stones present?

Answer 6

• Colicky loin to groin pain
• Haematuria
• Nausea and vomiting
• Sepsis
• Dysuria

Question 7

What is the main way renal stones are diagnosed?

Answer 7

Non-contrast CT-KUB

Question 8

What other diagnostic methods are there fore renal stones?

Answer 8

• Urine dipstick and culture

* Bloods-infection and kidney function

Question 9

What is the analgesic management of renal stones?

Answer 9

NASID’s

Question 10

What NSAID’s can be used in the management of kidney stones/ renal colic?

Answer 10

Diclofenac-main

Ibuprofen

Question 11

What are other forms of management for renal stones?

Answer 11

Extracorporeal shockwave lithotripsy

Question 12

What can be used as prophylaxis against renal stones?

Answer 12

Thiazide

Question 13

What is staghorn calculus?

Answer 13

Renal calculus forms in the shape of a staghorn

Question 14

Where does a staghorn calculus form?

Answer 14

Body in pelvis, horn in renal calyx

Question 15

What is a staghorn calculus composed of?

Answer 15

Struvite

Question 16

What is a staghorn calculus associated with?

Answer 16

Proteus infection- proteus mirabilis

(Recurrent upper urinary tract infections)

Question 17

What is struvite?

Answer 17

Ammonium magnesium sulphate

Question 18

How is a staghorn calculus diagnosed?

Answer 18

X-ray

Question 19

What is the main complication of diclofenac?

Answer 19

Increased risk of cardiovascular events

Question 20

What is the management of Stones < 5 mm?

Answer 20

They normally pass spontaneously within 4 weeks of symptom onset

Question 21

When would more urgent treatment be required for someone presenting with renal stones?

Answer 21

Ureteric obstruction
Renal developmental abnormality- horseshoe kidney
Previous renal transplant

Question 22

What situation would be classed as a surgical emergency in someone presenting with renal stones?

Answer 22

Ureteric obstruction due to stones together with infection

Question 23

What is the management of ureteric obstruction along with infection?

Answer 23

Decompression

Nephrostomy tube placement
Insertion of ureteric catheters
Ureteric ste

Question 24

What would be the management of a stone burden of less than 2cm in aggregate?

Answer 24

Shockwave lithotripsy

Question 25

What would be the management of a stone burden of less than 2cm in pregnant females?

Answer 25

Ureteroscopy

Question 26

What would be the management of large (>2cm), complex renal calculi and staghorn calculi?

Answer 26

Percutaneous nephrolithotomy

Question 27

What is the problem with NSAID’s such as diclofenac and ibruprophen?

Answer 27

Increased risk of cardiovascular events

Question 28

What does
–acute-onset loin-to-groin pain
–Hypotension
–Temperature
suggest?

Answer 28

Obstructive urinary calculi
manage with urgent renal decompression and IV antibiotics due to the risk of sepsis

Question 29

What are the different ways in which decompression can be achieved?

Answer 29

Percutaneous ureteroscopy or percutaneous nephrostomy

Question 30

Why would you use uteroscopy in the management of pregnant females with renal stones?

Answer 30

Lithotripsy is contraindicated