Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

304: Urology + Breast > Renal stones > Flashcards

Renal stones Flashcards

1
Q

Epidemiology

A

M>F

Prevalence= 20% in western society

Ethnicity= white

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors

  • Intrinsic
  • Extrinsic
A

Intrisic

  • Age: 20-50
  • Sex (M>F)
  • Race (white)
  • Genetics: 25% have family history (i.e cysteinura, xanthine, hypercalciuric)

Extrinsic

  • Occupation
  • Geography
  • Diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of stones and prevalence

A

Most common= calcium oxalate (60%)

Calcium phosphate (20%)

10%- Urate

8%- Strivite

1%- Cysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Aetiology

A

Based on different states of urine saturation

Crystallisation occurs when concentration is high and inhibitors of crystal growth are not effective

Metabolic

  • Hyperparathyroidism
  • Hypercalciuria
  • Sarcoid
  • Too much vit D

Familial

  • Cystienuria
  • Purine metabolic error
  • Xanthinuria

Infection

Impaired drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Inhibitors of stone formation

A

citrate

  • Phytate
  • Magnesium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Presentation of renal stones

A

Renal colic

  • Loin to groin radiation
  • Difficult to get comfortable

Haematuria

UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigations

A

U+Es
- Cr, urea, K+

Ca2+

PTH
- Causing hypercalcaemia

eGFR

Urine

  • Infection
  • pH
  • Culture

Stone analysis if stone has been passed

Imaging

  • XR KUB
  • Non contrast CT (gold standard)
  • Isotope renograph (long term)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management options for stones

A

Conservative
- Small stones that are non-obstruction, wait for it to pass

Medical

  • To relax ureter
  • Medical expulsive therapy
  • Chemolysis (uric acid stones)

Shock lithotripsy (ESWL)

  • Extracorporeal shock wave lithotripsy
  • Targeted on calculus

Ureteroscopy
- Uterosc

PCNL (percutaneous nephrolithotomy)
- Better for bigger stones (in renal pelvis/ calyces)

Lap/ open surgery rarely used
- Large staghorn or complex stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non-contrast CT

- advantages

A

100% sensitivity
and very high specificity

Helps to identify location of stones

Idea of pathology

Stone fragility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Non-contrast CT

- disadvantages

A

Radiation dose
- But lower dose can be used

Non-dynamic due to dye not being used

Obstruction is implied not directly known

  • Perinephric stranding
  • Hydronephrosis
  • Hydroureter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Conservative treatment

  • Stone size
  • Stone position
A

Stone size
- <4mm= 80% of passing

Stone position
- The more proximal, the harder it is to pass

If at VUJ, <5mm= 95% spontaneous passage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Indications for non-conservative intervention

A

Uncontrolled persistent pain

Infection

Deteriorating rena; function

Single kidney

Stone is not moving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Shock wave lithotripsy

  • Process
  • Mechanism
A

Shock waves focused on stone. Different wave types

  • Electrohydraullic
  • Electromagnetic etc

Waves fragments stones

Requires 2-3 sessions

Mechanism
- Positive then negative pressure creates cracks in the stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Shock wave lithotripsy

- Success rates

A

Renal pelvis stones most successful (86-89%)

Lower pole= lowest success rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Complications from ESWL

A

Steinstrasse
- Fragments form on top of each other

Residual fragment re-growth
- fragments can start to regrow

Fragment colic

Sepsis

Maco haemuturia- common

Haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ureteroscopy

A

Scope passed from urethra–> bladder–> ureter

  • Uses laser to fragment scope
  • Cannot look into kidney

Flexible scope
- allows kidney calyces to be seen

17
Q

Ureteroscopy

- Success rate

A

More successful than ESWL for mid and distal ureter

Similar success rate for proximal ureter with ESWL

18
Q

PCNL indications

A

Large stones (>2cm)

Complex stones

  • Multiple stones
  • Lower pole
  • Abnormal anatomy
  • Calyx diverticulum
  • Difficult access
  • Calcified stents
19
Q

Indications for lap and open surgery

A

Lap

  • If ESWL or Scope surgery has failed
  • Very large stones in ureter
  • Reconstructive also being done

Open
- Very rare

20
Q

Prevention of stones

A

Increase fluid intake

  • Dilutes urine
  • 2.5L

Lose weight

Good diet
- High in citrate

Low salt

  • <6g/day
  • less animal protein

Avoid XS sugar

Urine alkalization

Thiazide

21
Q

Calcium stones

A

Most common type

  • Oxalate the most common
  • Phosphate is less common
22
Q

Struvite stones

  • Composition, shape
  • Cause
A

Mg, ammonium, calcium phosphate

  • 2nd most common type
  • Occurs due to chronic UTI

Staghorn calculi

23
Q

Uric acid stones

A

Radiolucent stones,
high levels of uric acid
- 5% of all stones (3rd most common)

24
Q

Acute management of renal colic

A
  1. Analgesia
    - diclofenac PR
  2. Antiemetic
    - Metoclopramide
  3. IV fluids

If stone <0.5cm, could wait to pass.
If emergency/ larger
- Nephrostomy/ stent insertion

304: Urology + Breast (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions