Stones Flashcards
Presentation
Sudden onset loin to groin pain Colicky - writhes Tender abdo Haematuria (micro or macro) Fever/rigors/N+V
Epidemiology/Risk factors
Peak age 30-50 M:F 3:1 Anatomical anomalies in kidneys/urinary tract FH HTN Gout Hyperparathyroidism Immobilisation Relative dehydration Hypercalciuria, hyperuricosuria Higher SES Calcium/vit D supplements
Investigations
Urine dip incl pH, micro
Bloods: FBC, CRP, U+E, calcium, phospate, urate, PT, G+S
Imaging: Non enhanced CT (XRKUB - passage of radio-opaque stones)
Stone analysis: first time, recurrent on prophylaxis, early recurrence
Indications for hosp admission
Fever Only one functioning kidney Inadequate pain relief Inability to take fluids Anuria Pregnancy
Initial management
Most stones <5mm pass <4weeks
Pain relief - NSAIDs (opiates)
Antiemetics and rehydration
Can treat conservatively (watch and wait/with medical expulsion (CCBs/alpha Bs)
Urgent/intensive treatment required
Ureteric obstruction
Renal developmental abnormality
PMH renal transplant
Emergency Management
Obstruction + infection
System must be decompressed
Options: nephrostomy tube, ureteric catheters, ureteric stent
Non emergency options
Shock wave lithotripsy
Percutaneous nephrolithotomy
Ureterscopy
Open surgery
Shock wave lithotripsy
Shock wave external to patient
Internally cavitation bubbles and mechanical stress -> stone fragmentation
Large stone frag. can -> obstruction
Risk solid organ damage from shock waves
Uncomfortable, will need analgesia during and after
Percutaneous nephrolithotomy
Intra corporeal lithotripsy - fragments removed
Ureteroscopy
Ureteroscope passed retrograde through urethra and into renal pelvis
If lithotripsy contraindicated (pregnancy) or complex stone disease
Usually sten?t left in situ for 4 weeks
Which intervention?
Ureteric calculi <5mm - conservative
Stone burden <2cm total - lithotripsy
Stone burden <2cm - pregnant - ureteroscopy
Complex renal calculi and staghorn calculi - precutaneous nephrolithotomy
