Renal Stones Flashcards
which stones are the most common?
Calcium based stones most common (oxalate/phosphate)
Calcium oxalate is by far the most common stone (~75%).
Presentation?
Loin → Groin - This can refer to pain in the testis, scrotum, labia. Also can have referred pain on the anterior thigh. The patient will not be able to lie still!
restless!!!
rigors, fever, dysuria, haematuria,
which ones are the only ones you cant see on Xray
uric acid stones
which kidney stones have Alkaline urine + proteus infection
calcium phosphate
which stone is the only one that is radiolucent?
uric acid
uric acid kidney stones - patient also has a history/presentation of ?
a high protein diet, gout and IBD
which stone is primarily caused by UTI’s
struvite
which stone has a staghorn calculus ?
struvite
which stone is Found in patients with cystinuria
cystine
The most common point of constriction?
vesico-ureteric junction
what is the Ix of choice ?
CT KUB
XR KUB still useful and will detect the majority of stones, good to check the passage of stones
Mx?
- for analgesia?
- for stones <5mm
- for stones >5mm?
Analgesia - Diclofenac
Stones <5mm
– Most pass spontaneously, increase fluid intake
Stones >5mm
Expulsive therapy – Nifedipine (10mg/8h) or Tamsulosin (0.4mg/d)
if <2cm:
Extracorporeal shockwave lithotripsy (break up stone) or ureteroscopy using a basket
if >2cm:
Percutaneous nephrolithotomy (keyhole surgery - if really big - use lithotripsy to break it up then suck it out)
Prevention
calcium based?
oxalate?
struvite?
urate?
cysteine?
Calcium based stones – Thiazide diuretic to decrease Ca excretion
Oxalate – Avoid oxalate rich foods, pyridoxine (B6) can decrease oxalate levels
Struvite – Treat infection with abx
Urate – Allopurinal
Cysteine – D-penicillamine
