(U)- Kidney Stones Flashcards

1
Q

What are the two key complications of kidney stones?

A

Obstruction
Leading to AKI

Infection
With obstructive pyelonephritis

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2
Q

What is the most common type of kidney stone?

A

Calcium-based stones
- Calcium oxalate (more common)
- Calcium phosphate

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3
Q

What are the risk factors for calcium stone formation?

A

Raised serum calcium
Low urine output

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4
Q

Asides from calcium-based stones, what other types of kidney stones are there?

A

Uric acid
Not visible on x-ray

Struvite
Produced by bacteria- associated with infection

Cystine
Associated with cystinuria- autosomal recessive disease

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5
Q

What is a staghorn calculus?

A

Stone forms in the shape of the renal pelvis

Body sits in the renal pelvis with horns extending into renal calyces, seen on x-ray

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6
Q

What are staghorn calculi stones commonly made of?

A

Struvite

In recurrent upper urinary tract infections, bacteria can hydrolyse urine to ammonia, creating solid struvite

Proteus Mirabilis

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7
Q

What is renal colic?

A

Presenting complaint in symptomatic kidney stones

Unilateral loin to groin pain

Colicky (fluctuating severity) as stone moves and settles

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8
Q

How can kidney stones present?

A

Renal colic

May also be:
- Haematuria
- Nausea or vomiting
- Reduced urine output
- Sepsis symptoms if infection is present

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9
Q

What investigations can be used for kidney stones?

A

Urine dipstick

Blood tests

AXR (can show calcium stones as they are radiolucent)

CT KUB (non-contrast) NICE recommend within 24 hours of presentation

Ultrasound KUB, negative result does not exclude stones

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10
Q

How are kidney stones managed?

A

NSAIDs
-Intramuscular diclofenac, IV paracetamol is an alternative if NSAIDs unsuitable

Antiemetics
Antibiotics
Watchful waiting
-If the stone is < 5mm 50-80% chance they will pass

Tamsulosin
Surgical intervention

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11
Q

What surgical interventions are available for kidney stones?

A

Extracorporeal shock wave lithotripsy
Shockwaves directed at stone under X-ray guidance, breaks up stones

Ureteroscopy and laser lithotripsy
Camera into urethra, bladder and ureter to identify stone

Stone broken up by lasers

Percutaneous nephrolithotomy
General anaesthetic- nephroscope inserted via patient’s back

Scope inserted into kidney to look at ureters, stones broken into smaller pieces and removed

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12
Q

What does NICE advise after one episode of renal stones?

A
  • Increased fluid intake
  • Add lemon juice to water (citric acid binds to urinary calcium)
  • Avoid carbonated drinks (phosphoric acid promotes calcium oxalate formation)
  • Reduce salt intake
  • Maintain normal calcium (Low calcium increases kidney stones risk)
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13
Q

What recommendations are there for calcium renal stones?

A

Reduce intake of oxalate-rich foods e.g.
- Spinach
- Beetroot
- Nuts
- Black tea

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14
Q

What recommendations are there for uric acid stones?

A

Reduce purine intake e.g.
- Kidney
- Liver
- Anchovies
- Spinach

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15
Q

What medications limit risk of recurring kidney stones?

A

Potassium citrate
Calcium oxalate stones and raised urinary calcium

Thiazide diuretics
Calcium oxalate stones and raised urinary calcium

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