Urinary Stones

Question 1

How do renal stones present?

Answer 1

Pain radiating to groin
Unable to get comfortable
Microscopic or gross hematuria
Infection

Question 2

Which stones are radio opaque?

Answer 2

Calcium oxalate
Struvite
Cysteine

Question 3

Which stones are radio Lucent?

Answer 3

Uric acid

Question 4

What are the risk factors for calcium oxalate stones?

Answer 4

Increased calcium: hyperparathyroid, high salt intake
Increased oxalate: dietary, not enough calcium in diet, too much bile acid?

Decreased solubility: dehydration, not enough citrate, RTA 1

Anatomical: medically sponge kidney

Question 5

What factors influence stone formation (broad)

Answer 5

Solvent amount
Solute amount
Urine inhibitors like citrate
Urinary stasis
PH (depends on stone)

Question 6

When do we refer kidney stones to Urology?

Answer 6

Pyrexia
Post renal failure
Persistent symptoms 
Previous problems (haven't passed others before)
Pretty big stone (>0.5cm)

Question 7

Gold standard for diagnosis stones

Answer 7

CT KUB

Question 8

Causes of struvite stones

Answer 8

chronic infection (klebsiella, proteus)

Question 9

Treatment of stones

Answer 9

1. Hydration!
2. Pain relief

If persisting….

3. Stent to drain urine
4. Ureteroscopy (gets distal stones)
5. Shock wave lithotripsy
6. Percutaneous nephrolithotomy

Question 10

Physiology of calcium stones

Answer 10

Calcium regulated in loop of henle: reabsorption

If cannot bind GI calcium, oxalate will bind renal calcium

Interstitium is hypertonic so a good environment for stones to form

Question 11

Should someone with calcium oxalate stones avoid milk?

Answer 11

No! Good to have appropriate GI calcium

Question 12

Which type of stones forms more in acidic environments?

Answer 12

Uric acid

Cysteine