stones Flashcards
most common renal stone
calcium oxalate
gold standard Ix for stones
non contrast CT KUB
presentation of a stone
pain!! colick, loin to groin, haematuria
prevention of a stone
increase fluid, can add lemon to water, avoid carbonated drinks and potassium citrate can be used if calcium is the problem
IX of stones
urine dip, FBC/CRP/U+E (exclude concurrent infection which is an emergency), US if pregnant then non contrast CT KUB
Medical Mx of stones
Analgesia (IM diclofenac is best), alpha blocker (SM relaxation of the ureter which makes stones easier to pass - this is only done if stones <1cm)
under what size can a stone normally pass
<5mm
when would a stone <5mm need Tx
ureteric obstruction, renal development abnormality (horseshoe kidney) and previous transplant
different surgical Tx options
1) ESWL 2) ureteroscopy (used in pregnancy) 3) percutaneous nephrolithotomy
which are the only radiopaque stones
urate acid
what are staghorn stones made of
struvite (formed by bacteria - proteus mirabilis)
Rf for stones
dehydrations, high calcium, low urine output
whats the normal location of stones
PUJ, crossing the pelvic brim and VUJ
reasons to admit someone for a stone
post obstructive AKI, uncontrollable pain, evidence of infection, bilateral, horseshoe kidney
what follow up is needed if a stone is managed conservatively
imaging in 4 weeks
complications of stones
infection and post renal AKI and recurrence
why do bladder stones form
urine stasis so common in chronic retention
how should pyonephrosis be treated (infection due to obstruction)
it is an emergency so needs urgent decompression with nephrostomy
how should staghorn stones be treated
percutaneous nephrolithotomy
what diuretics can be used if someone has stones secondary to hypercalcaemia
thiazides
contraindications to ESWL
pregnancy, coagulopathies, UTI
ESWL complications
pain (patient will be given analgesia for the procedure), stone fragments which may then obstruct ureter, may need multiple sessions
stones over what size need to be treated with a percutaneous nephrolithotomy
> 20mm
Mx of choice for pregnant women with stones
ureteroscopy
prevention of different stone types
allopurinol - urate
penicillamine - prevent cysteine stones
ammonium chloride - stop development of struvite
thiazides - prevent calcium stones
what is the preferred management of a stone <2cm if no contraindications IE pregnant
lithotripsy
if NSAID not working for colic pain, what can be done next
IV paracetamol
AND alpha blockers for stones <10mm to help with the passage of the stone
