Renal Stones

Question 1

How do renal stones present?

Answer 1

Often asymptomatic and picked up on other investigations.
Renal colic.
Tenderness over the loin.
Haematuria.

Question 2

What is renal colic?

Answer 2

Stretches and spasms of the ureter.

Question 3

What are the symptoms of renal colic?

Answer 3

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.

Question 4

What are the five types of renal stones?

Answer 4

Calcium phosphate.
Calcium oxalate and calcium phosphate.
Uric acid.
Struvite (ammonium, magnesium, phosphate).
Non-calcium.

Question 5

What is the aetiology of renal stones?

Answer 5

Decreased water content.
Increased mineral content.
Decreased solute solubility.

Question 6

What can lead to decreased water content as a cause of renal stones?

Answer 6

Dehydration.

Question 7

What can lead to increased mineral content as a cause of renal stones?

Answer 7

Hypercalcaemia.
Hypercalciuria.
Hyperoxaluria.
Hyperuricaemia.

Question 8

What can lead to decreased solute solubility as a cause of renal stones?

Answer 8

Acidic or alkaline urine.

Question 9

What can cause hypercalaemia?

Answer 9

Increased PTH or vit D.
Bone destruction.
Thiazide diuretics.

Question 10

What can cause hyperoxaluria?

Answer 10

High intake.

Crohn’s increases absorption.

Question 11

What can cause hyperuricaemia?

Answer 11

Gout.

Chemo-cell turnover high.

Question 12

What type of renal stone causes acidic urine?

Answer 12

Calcium phosphate stones.

Question 13

What are the differential diagnoses for renal stones?

Answer 13

Aortic aneurysm dissection or rupture.
Biliary colic.
Pyelonephritis.
Appendicitis.
Pancreatitis.
Testicular torsion.

Question 14

What investigations should be performed if renal stones are suspected?

Answer 14

1. Urine dip.
2. Midstream urine for culture.
3. Bloods – CRP, renal function, creatinine, phosphate, calcium.
4. USS then non-enhanced CT to confirm diagnosis.

Question 15

What is the immediate management for renal stones?

Answer 15

DICLOPHENAC IM and lots of fluids.

Anti-emetics if needed.

Question 16

What is the home management for renal stones?

Answer 16

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.

Question 17

When is hospital management needed for renal stones?

Answer 17

Needed if complications occur, the person has known renal problems, they are unable to manage the pain, poor social support etc.

Question 18

What is the possible surgical management for renal stones?

Answer 18

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.