Urinary Stone

Question 1

What is renal calculi?

Answer 1

Kidney stone

Question 2

Who is more often affected by kidney stones?

Answer 2

Men at a 2.5 to 1 ratio
Initial presentation often between third and fifth decade
There are five major types of stones

Question 3

What are the most common types of stones?

Answer 3

Calcium (85%) visible on radiograph
Greatest occurrence during summer months

Associated with sedentary lifestyle, hypertension, carotid calcification, and cardiovascular disease

High protein and salt intake as well as dehydration appear to be the most significant dietary factors.

Question 4

What are the signs and symptoms of urinary stones?

Answer 4

Sudden pain, typically localized to the flank, associated with nausea and vomiting, constantly moving to find comfortable position.

Pain may occur episodically and radiate to the abdomen.

As the stone progresses down the ureter ipsilateral groin pain may present.

Obstructing stones normally present with acute, unremitting and severe colic.

Stone size does not correlate with the severity of symptoms.

Question 5

What are some lab findings?

Answer 5

Usually reveals microscopic or gross hematuria (90%)
Absence of hematuria doesn’t exclude urinary stones
Urinary pH is a valuable clue into the cause of possible stones

Question 6

What will you see on imaging?

Answer 6

Plain abdominal radiograph
Renal ultrasound with KUB will diagnose 80% of stones

Question 7

What is the treatment for urinary stone?

Answer 7

Forced IV will not push stones down the ureter
Forced diuresis can be counterproductive and exacerbate the pain
Stones smaller than 5-6 mm in diameter usually pass spontaneously
Alpha blocker tamsulosin .4mg PO daily
Prednisone 10mg PO daily for 3-5 days

Question 8

What is the surgical treatment for urinary stone?

Answer 8

Surgical removal or required for those that are showing signs of obstruction or infection.

Uteroscopic stone extraction
Extracorporeal shock wave lithotripsy

Question 9

How do you reduce recurrence?

Answer 9

Dietary modification

Increase fluid intake
2.5l a day
Encouraged to drink enough to make pt wake to void

Sodium intake should be restricted to keep urinary levels beneath 150

Spread animal protein intake throughout the day to 1g/kg/day

Question 10

What are some complications?

Answer 10

Obstructing stone with infections is a medical emergency.

Refer to urology for stones that don’t pass after four weeks.