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Phase 4 Surgery > Renal Stones > Flashcards

Renal Stones Flashcards

1
Q

What are the different types of renal stones?

A

Calcium oxalate (most common),
Calcium phosphate,
Struvite,
Uric acid
Cystine

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2
Q

Describe features of calcium oxalate stones

A

They precipitate at low saturation levels so they are the most common. Risk factors include: Hypercalcaemia and low urine output, Hyperoxaluria.

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3
Q

Describe features of calcium phosphate stones?

A

Occurs in renal tubular acidosis types 1 and 3. Low urine volume, hyperparathyroidism

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4
Q

Describe features of struvite stones

A

Stones formed from magnesium, ammonium and phosphate. Occur as a result of urease producing bacteria and therefore associated with chronic infections

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5
Q

Describe features of cystine stones

A

Associated with homocystinuria which is an inherited defect.

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6
Q

Where are the three most common areas for stones to become inpacted?

A

Pelviureteric junction (where renal pelvis becomes ureter)
Crossing the pelvic brim
Vesocpureteric junction (where ureter enters bladder)

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7
Q

What are features of urate stones?

A

Occur because of high purine levels from diet (red meats) or haematological disorders. Not seen on x-rays

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8
Q

What are the signs and symptoms of renal stones?

A
  • Severe, intermittent loin to groin pain,
  • Restlessness,
    -Haematuria
  • Nausea and vomiting,
  • Secondary infection
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9
Q

What are the general risk factors for renal stones?

A

Dehydration,
Hypercalciuria, hyperparathyroidism and hypercalcaemia
Cystinuria
High dietary oxalate
Renal tubular acidosis 1 +3
PKD
Gout
ileostomy (loss of bicarbonate which causes acidic urine and uric acid)
Drugs eg, loop diuretics, steroids, theophylline

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10
Q

What diuretics can promote or prevent renal stones?

A

Loop diuretics - promote
Thiazide diuretics - prevent as they increase DCT calcium reabsorption

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11
Q

What are some differential diagnosis for renal stones?

A

Pyelonephritis, appendicitis, diverticulitis, ovraian torsion, ectopic pregnancy, ruptured AAA

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12
Q

What are the investigations for renal stones?

A
  1. Urine dip
  2. Bloods - FBC, CRP, UEs, urate and calcium levels
  3. Imaging: Gold standard is non-contrast CT KUB in first 24 hours
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13
Q

What is the management of renal stones?

A
  • Analgesia: PR diclofenac or IV paracetamol
  • Medical expulsion with tamsulosin if stone <5mm
  • Lithotripsy if stone is < 2cm
  • Ureteroscopy if pregnant and stone is < 2cm
  • Complex stones or staghorn calculi then do percutaneous nephrolithotomy
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14
Q

When should you admit a patient with renal stones?

A
  • Obstructive AKI
  • Uncontrollable pain
  • Evidence of infection
  • Large stones > 5mm
  • Person requires IV fluids
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15
Q

What is extracorporeal shock wave lithotripsy?

A

Sonic waves are used to break up the stone which will then pass spontaneously. Used in stones less than 2cm. Contraindicated in pregnancy

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16
Q

What is ureteroscopy?

A

Ureteroscope is passed through ureter into renal pelvis. In most cases a stent is left. Mainly for pregnancy.

17
Q

What is percutaneous nephrolithotomy

A

Procedure where access is gained into renal collecting system. Once access gained lithotripsy is performed and stones removed.

18
Q

How can you prevent renal stones from forming?

A

For calcium stones - Thiazide diuretics
For uric acid stones - allopurinol
For oxalate stones - Cholestyramine

19
Q

What are the complications for renal stones?

A

Urine outflow obstruction which can lead to AKI or infection.
Infection
Renal carcinoma
CKD
Rupture

20
Q

What are the metabolic investigations for patients with renal stones?

A
  • Blood testing - look for serum calcium, PTH levels,
  • Stone analysis
21
Q

What is a staghorn calculi?

A

Stone which takes up whole renal pelvis. Normally struvite stones

22
Q

What is the management of ureteric stones?

A

If < 10mm then shockwave lithotripsy +/- alpha blockers.
10-20mm then ureteroscopy

Phase 4 Surgery (58 decks)

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