Renal Stones Flashcards
How do renal stones present?
Often asymptomatic and picked up on other investigations.
Renal colic.
Tenderness over the loin.
Haematuria.
What is renal colic?
Stretches and spasms of the ureter.
What are the symptoms of renal colic?
SUDDEN SEVERE PAIN radiating anywhere from the costovertebral angle or groin and can radiate down into scrotum/labia and anterior thigh.
WRITHE AROUND in agony.
Pain is often followed by a dull ache before the colic.
What are the five types of renal stones?
Calcium phosphate. Calcium oxalate and calcium phosphate. Uric acid. Struvite (ammonium, magnesium, phosphate). Non-calcium.
What is the aetiology of renal stones?
Decreased water content.
Increased mineral content.
Decreased solute solubility.
What can lead to decreased water content as a cause of renal stones?
Dehydration.
What can lead to increased mineral content as a cause of renal stones?
Hypercalcaemia.
Hypercalciuria.
Hyperoxaluria.
Hyperuricaemia.
What can lead to decreased solute solubility as a cause of renal stones?
Acidic or alkaline urine.
What can cause hypercalaemia?
Increased PTH or vit D.
Bone destruction.
Thiazide diuretics.
What can cause hyperoxaluria?
High intake.
Crohn’s increases absorption.
What can cause hyperuricaemia?
Gout.
Chemo-cell turnover high.
What type of renal stone causes acidic urine?
Calcium phosphate stones.
What are the differential diagnoses for renal stones?
Aortic aneurysm dissection or rupture. Biliary colic. Pyelonephritis. Appendicitis. Pancreatitis. Testicular torsion.
What investigations should be performed if renal stones are suspected?
- Urine dip.
- Midstream urine for culture.
- Bloods – CRP, renal function, creatinine, phosphate, calcium.
- USS then non-enhanced CT to confirm diagnosis.
What is the immediate management for renal stones?
DICLOPHENAC IM and lots of fluids.
Anti-emetics if needed.
What is the home management for renal stones?
Wait for stone to pass if <5mm (should be within 3 weeks).
Can take paracetamol or codeine if needed.
Advice on what to look out for if it does get worse.
When is hospital management needed for renal stones?
Needed if complications occur, the person has known renal problems, they are unable to manage the pain, poor social support etc.
What is the possible surgical management for renal stones?
ESWL – Shock waves break up the stones.
Ureteroscopy – Laser breaks up the stones (indicated where ESWL is contraindicated e.g. pregnant females).
Percutaneous nephrolithotomy – Stones > 2cm are removed.
