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Peri-op > Urinary Tract Calculi > Flashcards

Urinary Tract Calculi Flashcards

1
Q

List 4 general risk factors for stones?

A
  1. Dehydration
  2. High dietary oxalate
  3. Renal tubular acidosis
  4. Polycystic kidney disease
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2
Q

List the 2 key complications of kidney stones?

A
  1. Obstruction leading to AKI
  2. Infection with obstructive pyelonephritis
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3
Q

What is the most common type of stone?

List the 2 types?

A

Calcium-based stones

  • Calcium oxalate (more common)
  • Calcium phosphate
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4
Q

List 2 key risk factors for calcium stones

A
  1. Hypercalcaemia
  2. Low urine output
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5
Q

How does hypercalcemia present?

A

Renal stones, painful bones, abdominal groans and psychiatric moans

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6
Q

List 2 drugs which precipitate calcium stones

A
  1. loop diuretics
  2. steroids
  3. acetazolamide
  4. theophylline
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7
Q

List the 3 key causes of hypercalcemia

A
  1. Calcium supplementation
  2. Hyperparathyroidism
  3. Cancer (ie. myeloma, breast or lung cancer)
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8
Q

Which drug may prevent calcium stones?

A

Thiazides (increase distal tubular calcium resorption)

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9
Q

List 3 other types of kidney stones

A
  • Uric acid (not visible on x-ray)
  • Struvite
  • Cystine
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10
Q

List 2 risk factors for urate stones

A
  1. gout
  2. ileostomy (loss of HCO3 and fluid results in acidic urine)
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11
Q

What are Struvite stones associated with?

A

Produced by bacteria, therefore, associated with infection

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12
Q

What are the components of a Struvite stone?

A

Magnesium, ammonium and phosphate

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13
Q

What are Cystine stones associated with?

A

Associated with cystinuria, an autosomal recessive disease

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14
Q

What is a Staghorn Calculus?

A

Stone forms in the shape of the renal pelvis and extends into at least 2 calyces

(resemble antlers of a deer)

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15
Q

Staghorn Calculus occur most commonly with what type of stone?

Why?

A

Struvite

In recurrent upper UTIs, bacteria hydrolyse urea in urine to ammonia, creating struvite

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16
Q

Which stones appear opaque on X-ray?

A
  1. Calcium Oxalate
  2. Mixed calcium/ oxalate phosphate
  3. Stag-horn calculi
  4. Calcium phosphate
17
Q

Which stones appear radio-lucent on X-ray?

A
  1. Urate stones
  2. Xanthine stones
18
Q

How do cystine stones appear on x-ray

A

Semi-opaque, ‘ground glass’ appearance

19
Q

How do renal stones present?

A

Renal colic (excruciating unilateral loin to groin pain which is colicky) +/-

  • Haematuria
  • Nausea or vomiting
  • Reduced urine output
  • Symptoms of sepsis, if infection is present
20
Q

Initial Imaging of choice for Renal stones?

A

Non-contrast CT KUB should be performed on all patients within 24 hours of admission

21
Q

List 4 other initial investigations for suspected stones

A
  1. urine dip and culture
  2. Renal function (serum creatinine + electrolytes)
  3. FBC / CRP
  4. calcium/urate
22
Q

Management of kidney stones < 5mm

A

Will usually pass spontaneously within 4wks

Tamsulosin (alpha-blocker) can help aid the spontaneous passage of stones

23
Q

Management in patients with obstructive stones with signs of infection?

A

URGENT renal decompression + IV antibiotics

(Options incl nephrostomy tube, ureteric catheters and ureteric stent)

24
Q

What is the treatment of stones > 10 mm In the non-emergency setting?

A
  1. Extracorporeal shock wave lithotripsy (ESWL)
  2. Percutaneous nephrolithotomy (PCNL)
  3. Ureteroscopy and laser lithotripsy
  4. Open surgery (rarely used)
25
Q

What is the analgesia of choice for kidney stones?

A

NSAIDs eg. IM diclofenac

(IV paracetamol is an alternative to NSAIDs)

26
Q

Advice to give patients to prevent Recurrent Stones

A
  1. Increase fluid intake (2.5 – 3 litres/day)
  2. Reduce dietary salt intake (< 6g per day)
  3. Add fresh lemon juice to water
  4. Avoid carbonated drinks
  5. Maintain a normal calcium intake
27
Q

List 2 foods you may recommend patients with calcium stones to AVOID

A

Oxalate-rich foods

eg. spinach, beetroot, nuts, rhubarb and black tea

28
Q

List 2 foods you may recommend patients with uric acid stones to AVOID

A

Purine-rich foods

eg. kidney, liver, anchovies, sardines and spinach

29
Q

List 2 medications which may be used to reduce the risk of recurrence in patients with calcium oxalate stones

A
  1. Potassium citrate for calcium oxalate stones
  2. Thiazide diuretics (e.g., indapamide)
30
Q

List 2 medications which may be used to reduce the risk of recurrence in patients with uric stones

A
  1. Allopurinol
  2. Oral bicarbonate

Peri-op (22 decks)

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