Renal stones Flashcards
Risk factors for stones
Chronic dehydration
Hypercalciuria, hyperparathyroidism, hypercalcaemia
PKD
FH
PMH eg horseshoe kidney
Drugs promote calcium stones: loop diuretics, steroids, acetazolamide, theophylline
Thiazides can prevent calcium stones by increasing distal tubular calcium resorption
SIX core signs and symptoms of stones
1) PAIN Renal pain dull and aching Excruciating spasms of renal colic ‘loin to groin’ (or genitals/inner thigh) 2) INFECTION- UTI, N+V, pyrexia 3) STERILE PYURIA 4) HAEMATURIA 5) PROTEINURIA 6) ANURIA
What are the symptoms of stag-horn calculi
None!
Investigations for stones (non-imaging)
FBC, U&E, Ca2+, PO4
3-, glucose, bicarbonate, urate
Serum creatinine and electrolytes for renal func
Urine dip and culture
Imaging for stones
Non-contrast CT (KUB= kidney ureters bladder)
USS (less sensitive)
Treatment for stones
Pain relief: diclofenac IV/IM
Can watch and wait if <5mm
Shockwave lithotripsy or
Uteroscopy (uses camera and little basket) or
Percutaneous nephrolithotomy (keyhole surgery) or
Open surgery!
Treatment for <5mm stones
Watch and wait
Name of stone removal with tube passed up and little basket
Uteroscopy
Name of procedure uses keyholes to remove stones
Percutaneous nephrolithotomy
General prevention renal stones
Inc fluid intake (add lemon to water)
Avoid carbonated drinks
Low salt
Normal Ca
Specific prevention of calcium stones
in hypercalciuria, a thiazide
diuretic is used to dec Ca2+ excretion into urine
Specific prevention of oxalate stones
dec oxalate intake (rhubarb and buckwheat and tea); pyridoxine may be used
Specific prevention of urate stones
Allopurinol
Most common cause of hypercalciuria
Primary hyperparathyroidism
Most common stone composition
Calcium
Calcium oxalate
Calcium phosphate
