Renal/Ureteric Colic

Question 1

What is renal/ureteric colic?

Answer 1

Acute and severe loin pain caused when a urinary stone moves from the kidney or obstructs the flow of urine

Question 2

What are the symptoms and signs of renal/ureteric colic?

Answer 2

• Loin to groin pain which is severe and colicky
• Nausea and vomiting
• LUTS (if stone in lower ureter)
• Occasional Haematuria
• Tachycardia
• Dehydration
• Tender Flank

Question 3

What causes renal/ureteric colic?

Answer 3

• Metabolic (50%)
• Urological (20%)
• Infection (15%)
• Immobilisation (5%)

Question 4

What are the metabolic causes of renal/ureteric colic?

Answer 4

• Type 1 Renal tubular acidosis
• Hyperparathyroidism
• Cystinuria
• Sarcoidosis
• Crohn’s disease

Question 5

What are the differentials for renal/ureteric colic?

Answer 5

• Urological: Pyelonephritis
• Gynae: ectopic pregnancy, torted ovarian cyst
• Gastro: appendicitis, diverticulitis
• Vascular: ruptured AAA
• Misc: Musculo-skeletal pain

Question 6

Where are the most common places for ureteric stones?

Answer 6

• PUJ
• Crossing iliac vessels
• VUK

Question 7

How would you investigate renal/ureteric stones?

Answer 7

• FBC
• U+Es
• Ca2+
• CRP
• Urine dipstick
• bHCG
• Non-contrast CT KUB or USS

Question 8

What is the general management of renal/ureteric stones?

Answer 8

• Analgesia

- Hydration

Question 9

What is the management of stones ≤5mm?

Answer 9

• Watchful waiting

- Followed up by imaging in 2 weeks

Question 10

When is tamsulosin considered as a treatment for stone passage?

Answer 10

<10mm

Question 11

What is the management of stones >5mm?

Answer 11

Shockwave lithotripsy (SWL) or ureteroscopy (URS)

Question 12

When would you prescribe potassium citrate as a follow-up medication?

Answer 12

• Children and young people with recurrent stones which are >50% calcium oxalate and have hypercalcuria or hypercituria
• Adults with recurrent stones which are >50% calcium ocalate

Question 13

When would you prescribe a thiazide diuretic as a follow-up medication?

Answer 13

Adults with recurrent stones which are >50% calcium oxalate and have hypercalciuria, after restricting Na+ intake to <6g/day

Question 14

What are the complications of a stone?

Answer 14

• Pyonephrosis
• Solitary functioning kidney/unilateral stones
• Intractable pain

Question 15

What is pyonephrosis?

Answer 15

Infected urine behind an obstructing ureteric stone

Question 16

How is pyonephrosis investigated and managed?

Answer 16

• US

- Nephrostomy tube insertion

Question 17

What are the types of renal/ureteric stone in order from most-least common?

Answer 17

1. Calcium oxalate (65-80%)
2. Calcium phospate (10-15%)
3. Struvite (10-15%)
4. Uric acid (5-10%)
5. Cystine (1%)

Question 18

What stones are opaque on a XR?

Answer 18

• Calcium oxalate

- Calcium phosphate

Question 19

Which stones are translucent on a XR?

Answer 19

Uric acid

Question 20

What predisposes patients to calcium oxalate stones?

Answer 20

• Primary hyperoxaluria
• IBD
• Bowel resection

Question 21

What predisposes patients to calcium phosphate stones?

Answer 21

• Primary hyperparathyroidism

- Renal tubular acidosis

Question 22

What predisposes patients to struvite stones?

Answer 22

• UTIs with organisms that produce urease enzymes

- Catheters

Question 23

What predisposes patients to Uric acid stones?

Answer 23

• Obesity
• DM
• High purinergic intake
• Gout
• Tumour lysis after chemotherapy

Question 24

Which types of stone can cause staghorns?

Answer 24

Struvite