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Renal/Urology > Renal Stones + Pyelonephritis > Flashcards

Renal Stones + Pyelonephritis Flashcards

1
Q

What is the other name for renal tract stones?

A

Urolithiasis

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2
Q

What are the different types of renal tract stones?

A 
Calcium (80%):
- calcium oxalate
- calcium phosphate
- mixed
Struvite (magnesium ammonium phosphate)
Urate
Cystine
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3
Q

What type of stones classically cause ‘stag horn calculi’?

A

Struvite

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4
Q

Which stones are radiolucent (can’t be seen on xray)?

A

Urate stones

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5
Q

What causes the development of urate stones?

A

High levels of purine in the blood

  • e.g. from diet (red meats)
  • or haematological disorders e.g. myeloproliferative disease
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6
Q

What causes the development of cystine stones?

A

Familial disorders affecting cystine metabolism - hypocystinuria

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7
Q

What are the three main locations when renal tract stones are found?

A

Natural narrowed points:

  • pelviureteric junction (PUJ)
  • where iliac vessels cross the ureter in the pelvis
  • vesicoureteric junction (VUJ)
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8
Q

What are the clinical features of a renal tract stone?

A 
Asymptomatic if non obstructing
Ureteric stone:
- pain --> ureteric colic
- sudden onset, 'loin to groin'
- associated nausea + vomiting
- haematuria in 90%
- fever, rigors if associated infection
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9
Q

How should suspected urolithiasis be investigated?

A 
Urinalysis +/- culture
Bloods:
- FBC + CRP
- U&Es
- urate + calcium levels
Imaging
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10
Q

Which imaging is gold standard for urolithiasis?

A

Non-contrast CT KUB

USS is useful to look for hydronephrosis in cases of known stone disease

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11
Q

What is the initial management of urolithiasis?

A

Often dehydrated so ensure adequate fluid intake
ANALGESIA - opiates + rectal NSAIDs (diclofenac)
Majority of stones pass spontaneously, especially if in lower ureter or < 5mm

If signs of infection –> IV antibiotics + urgent urology referral

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12
Q

What is the criteria for inpatient admission for urolithiasis?

A

Post obstructive AKI
Uncontrolled pain from simple analgesia
Evidence of infection
Large stones (>5mm)

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13
Q

Which methods are used to temporarily relieve obstruction in urolithiasis if there is nephropathy or infection?

A

Stent insertion:
- into ureter via cystoscopy
or Nephrostomy:
- tube directly into renal pelvis to relieve the obstruction proximally

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14
Q

What are the options for definitive management of renal/ureteric stones which do not pass spontaneously?

A

Extracorporeal shock wave lithotripsy (ESWL)
Percutaneous nephrolithotomy (PCNL)
Flexible uretero-renoscopy (URS)

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15
Q

What is extracorporeal shock wave lithotripsy (ESWL) and when is it used/contraindicated?

A

Targeted sonic waves to break up stone
Used for small stones (<2cm)
CI: pregnancy or stone positioned over bony landmark e.g. pelvis

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16
Q

What is percutaneous nephrolithotomy (PCNL) and when is it used?

A

Used of renal stones only –> best method for large renal stones including staghorn calculi

Percutaneous access to kidney, nephroscope passed into renal pelvis + stones fragmented using lithotripsy

17
Q

What is flexible uretero-renoscopy (URS)?

A

Scope passed retrograde up into ureter + stones fragmented through laser lithotripsy

18
Q

What are the main complications of urolithiasis?

A

Infection
Post-renal AKI
Recurrent renal stones –> renal scarring and loss of kidney function

19
Q

What causes bladder stones?

A

Urine stasis –>chronic urinary retention
Infection –> schistosomiasis
Passed ureteric stones

20
Q

What are the clinical features of pyelonephritis?

A

Classical triad:

  • fever
  • unilateral loin pain
  • nausea + vomiting

May be symptoms of lower UTI + haematuria
Costovertebral angle tenderness

21
Q

How should suspected pyelonephritis be investigated?

A

Urinalysis + culture
Beta-HCG
Routine bloods

If evidence of obstruction:

  • renal USS (infected obstruction is urological emergency)
  • then non-contrast CT KUB
22
Q

How is pyelonephritis managed?

A

If uncomplicated - antibiotics in the community

If systemically unwell -

  • ABCDE
  • IV fluids + empirical antibiotics
  • analgesia + anti-emetics
23
Q

What are the complications of pyelonephritis?

A 
Severe sepsis
Renal scarring --> CKD
Pyonephrosis (infected obstructed kidney)
Preterm labour in pregnant women
Chronic pyelonephritis --> CKD
Emphysematous pyelonephritis
24
Q

What is emphysematous pyelonephritis?

A

Rare, sever pyelonephritis caused by gas forming bacteria –> high mortality
Most commonly seen in diabetics
CT –> gas within and around the kidney

Renal/Urology (13 decks)

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