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Urology > Renal stones > Flashcards

Renal stones Flashcards

1
Q

What are urinary tract stones also referred to as?

A

urolithiasis

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2
Q

What are kidney stones also referred to as?

A

nephrolithiasis

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3
Q

Where do stones tend to form?

A
  1. pelviureteric junction
  2. pelvic brim
  3. vesicoureteric junction
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4
Q

What is the peak age for urinary stone to form??

A

20-40

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5
Q

What are the different types of stones?which is the most common?

A

Calcium oxalate - 75%
Magnesium ammonium phosphate (struvite/triple phosphate - 15%)
Urate 5%
Hydroxyapatite 5%

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6
Q

How can urinary tract stones presents?

A

Asymptomatic or

  1. Pain + N&V
  2. Infection co-existing
  3. Haematuria
  4. Proteinuria
  5. Sterile pyuria
  6. Anuria
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7
Q

What is the character of pain that can be experienced with urinary stones?

A

Excruciating spasms of renal colic Loin to groin

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8
Q

Where is kidney obstruction pain felt?

A

loin between rib 12 and lateral edge of lumbar muscles

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9
Q

How does obstruction of mid-ureter present?

A

mimic appendicitis or diverticulitis

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10
Q

How can obstruction of lower ureter present?

A

sx of bladder irritability and pain in scrotum, penile tip or labia major

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11
Q

how does obstruction in bladder or urethra present?

A

pelvic pain
dysuria
strangury - desire but inability to void
+/- interrupted flow

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12
Q

What blood tests would u order

A 
FBC
U&E
ESR/CRP 
Ca2+
PO43-
Glucose
Bicarb
Urate
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13
Q

What urine tests would u do

A
  1. Urine dipstick + culture - usually +ve for blood
  2. MSU:
    i. MC+S
    ii. Urine pH
    iii. 24hr urine for: calcium, oxalate, urate, citrate, sodium, creatinine
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14
Q

What imaging would u do

A
  1. Non-contrast CT KUB(99% visible)
  2. KUB XR (80% visible)
  3. US for hydronephrosis or hydroureter
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15
Q

What is the initial treatment of renal stones/colic?

A

diclofenac 75mg IM/IV
If CI: opioids
+ IV fluids if unable to tolerate PO
Abx if infection

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16
Q

What is rx of stones <5mm

A

90-95% pass spontaneously

17
Q

What is rx of stones >5mm/pain not resolving?

A

Medical expulsive therapy:

  1. Nifedipine PO or alpha-blockers
  2. Extracorporeal shockwave lithotripsy (ESWL) or ureteroscopy using a basket
  3. Percutaneous nephrolithotomy
18
Q

What intervention is used to remove large, multiple or complex stones?

A

percutaneous nephrolithotomy

19
Q

What are the indications for urgent intervention?what is the intervention

A
  • presence of infection AND obstruction
  • urosepsis
  • intractable pain or vomiting
  • impending AKI
  • obstruction in a solitary kidney
  • bilateral obstructing stones
20
Q

What is rx of stone present w infection and obstruction?

A

percutaneous nephrostomy or ureteric stent

21
Q

What are the general preventative measures for stones?

A

drinks plenty

normal dietary calcium intake

22
Q

What is prevention of calcium stones?

A

in hypercalciuria, thiazide diuretic to reduce Ca2+ excretion

23
Q

What is prevention of oxalate stones?

A

reduce oxalate intake

e.g. darker coloured fruits and veg

24
Q

What is the prevention of struvite stones?

A

treat infection (stones form readily in urine of those that are infected w ammonia producing organisms)

25
Q

What is the prevention of urate crystals?

A

allopurinol

26
Q

What is the prevention of cystine stones

A

vigorous hydration to keep UO >3L/day and urinary alkalinisation

27
Q

What are the causes of calcium stones?

A 
high fluid intake
low animal protein, low salt diet (a low calcium diet has not been shown to be superior to a normocalcaemic diet)
thiazides diuretics (increase distal tubular calcium resorption)
28
Q

when do stones become an emergency?what is the treatment?

A 
when ureteric stones cause obstruction in the presence of infection
rx:
- nephrostomy tube placement 
- ureteric catheter
- ureteric stent

Urology (11 decks)

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