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Renal, Urinary and Bladder > Renal Stones > Flashcards

Renal Stones Flashcards

1
Q

Epidemiology of stone disease?

A

3M:1F

Peak incidence 30-50y

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2
Q

Risk of recurrence of renal stones at 1/5/lifetime?

A

10% recurrence at 1 year; 50% recurrence at 5 years; 60-80% lifetime risk.

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3
Q

Hereditary RFx for renal stones?

A

RTA, G6PD, cytinuria, xanthinuria, oxaluria.

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4
Q

Lifestyle RFx for renal stones?

A

minimal fluid intake; excess vitamin c, oxalate, purines, calcium, animal protein ++

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5
Q

Medications RFx for renal stones?

A

Loop diuretics (frusemide); acetzolamide, topiramate, zonisamide.

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6
Q

Medical conditions RFx for renal stones?

A

UTI (with urea-splitting organisms); myeloproliferative disorders, IBD, gout, DM, hypercalcaemia disorders, sarcoidosis, obesity (>30).

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7
Q

What causes pain in renal stones?

A

Urinary obstruction -> upstream distension -> pain.

  • Flank pain from renal capsular distension (non-colicky)
  • Severe waxing and waning pain radiating from flank to groin/testis/tip of penis due to stretching or collecting system or ureter (ureteral colic).
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8
Q

CFx of renal stones?

A

Storage and voiding LUTS; terminal haematuria; suprapubic pain.

  • N/V
  • Diaphoresis
  • Tachycardia/tachypnoea
  • +/- trigonal irritation (F, U)
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9
Q

GU Ddx of renal colic?

A
  • Pyelonephritis
  • Ureteral obstruction of other cause (UPJ obstruction, clot colic 2” to gross haematuria)
  • Gynaec: ectopic pregnancy, ovarian cyst torsion/rupture, PID.
  • Testicular torsion
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10
Q

Abdominal Ddx of renal colic?

A
  • AAA
  • Bowel ischaemia
  • Pancreatitis
  • Other acute abdomen
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11
Q

Neurological Ddx of renal colic?

A

-Radiculitis (L1): herpes zoster, nerve root compression.

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12
Q

What are the narrow points for upper tract stones?

A
  • UPJ
  • Pelvic brim
  • Under Vas deferens/ broad ligament
  • UVJ
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13
Q

Outline the features in pathogenesis of renal stones.

A
  • Supersaturation of stone constituents
  • Stasis, low flow and low volume (dehydration)
  • Crystal formation and stone nidus
  • Loss of inhibitory factors
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14
Q

Which factors inhibit stone formation?

A
  • Citrate (forms soluble complex with calcium)
  • Magnesium (forms soluble compound with oxalate)
  • pyrophosphate
  • Tamm-Horsfall glycoprotein
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15
Q

Indications for hospital admission in renal stones?

A
  • Intractable pain / vomiting
  • Fever
  • Compromisesd renal fxn (single kidney, bilateral obstruction)
  • Pregnancy
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16
Q

How should septic patients with stones be managed?

A

Urgent decompression via ureteric stent or percutaneous nephrostomy.
Delay definitive Rx until clearance of infection.

17
Q

Ix in renal stones?

A
  • FBE
  • UEC
  • Serum calcium and uric acid
  • MSU
  • Xray KUB
  • CT KUB (or CT IVP)
18
Q

Acute medical management of renal stones?

A
  • Analgesis +/- antiemetic
  • NSAIDs
  • Medical explulsion therapy
  • IV fluids (if vomiting)
19
Q

Why are NSAIDs used in renal stones in acute medical management?

A

Pain

Help lower intra-ureteral pressure

20
Q

What is medical expulsion therapy?

A
  • alpha blockers (increase rate of spontaneous passage in distal ureteral stones)
  • CCBs
21
Q

Indications for interventional management of renal stones?

A
  • Infection / sepsis
  • Renal impairment
  • Bilateral obstruction
  • Solitary kidney
  • Inability to control Sx
  • Prolonged obstruction
  • Spontaneous passage unlikely
22
Q

Interventional options for management of renal stones?

A
  • JJ stent and delayed management
  • Ureteroscopy and lithotripsy
  • Shock wave lithotripsy
  • Percutaneous nephrostomy
23
Q

What is first line treatment for ureteral stones >10mm?

A

Extracorporeal shock wave lithotripsy (ESWL)

24
Q

Dietary modifications for prevention of renal stones?

A
  • Increased fluid (>2L/day), K+ intake
  • reduce animal protein, oxalate, Na+, sucrose, fructose intake
  • avoid high dose vitamin C supplements
25
Q

Medication alterations for prevention of renal stones?

A
  • Thiazide diuretics for hypercalciuria
  • Allopurinol for hyperuricosuria
  • Potassium citrate for hypocitraturia, hypyeruricosuria
26
Q

Features of calcium stones?

A
  • Radioopaque on KUB

- Reducing dietary Ca2+ NOT an effective prevention method

27
Q

Treatment of calcium stones

A

-Increase fluids >2L/d
Calcium stones: Cellulose phosphate, orthophosphate for absorptive causes
Calcium oxalate: thiazides, +/- potassium citrate +/- allopurinol.
Calcium struvite: ABx (must remove stone)

28
Q

Aetiology of uric acid stones?

A

Uric acid precipitates in low volume, acidic urine with a high uric acid concentration.

29
Q

Key features of uric acid stones on imaging?

A
  • Radiolucent on KUB

- Radioopaque on CT

30
Q

Treatment of uric acid stones?

A
  • Increased fluid intake
  • Akalinisation of urine to pH 6.5-7 (bicarb, potassium citrate)
  • +/- allopurinol (if serum uric acid levels elevated)
31
Q

Aetiology of struvite stones?

A
  • Infection with urea splitting organisms (e.g. proteus, pseudomonas)
  • Produces alkaline urinary pH and precipitation of struvite (magnesium ammonium phosphate)
32
Q

Hx features to elicit in renal colic?

A
  • Pain characteristics
  • ?Previous episodes and outcomes
  • Complicating factors: pregnancy, renal impairment
  • FHx
33
Q

What proportion of renal stones are radiopaque?

A

90%

34
Q

Common cause of obstructive pylonephrosis?

A

Usually GNB (E.Coli)

35
Q

Management of obstructive pyelonephrosis?

A
  • IV Abx (G-ve and enterococcus coverage)
  • Urgent decompression (nephrostomy, JJ stent)
  • Supportive (fluids, monitoring, +/- ICU/HDU)
36
Q

What does spontaneous passage of renal stone depend on?

A
  • Max size in transverse plane
  • Location
  • PHx of stone passage
37
Q

Explain physiology of medical expulsive therapy?

A
  • Ureter wall contain a1 R that mediating SM contraction
  • a-blockers relax ureteric wall
  • stone pass inc by 30%
38
Q

Medical expulsive therapy dose?

A

Tamsulosin 0.4mg OD x 2/52

39
Q

Follow up of renal stones?

A
  • Home with analgesia
  • Stain urine
  • F/u imaging (XKUB if visible on Xray)

Renal, Urinary and Bladder (15 decks)

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