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Renal & Urology > Urinary Tract Calculi > Flashcards

Urinary Tract Calculi Flashcards

1
Q

Define Urinary Tract Calculi?

A

Crystal Deposition within the urinary tract

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2
Q

What is Urinary Tract Calculi also known as?

A

Nephrolithiasis

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3
Q

What are the type of stones that are present in Urinary Tract Calculi?

A

Calcium Oxalate - Most Common
Struvite - quite common
Urate - 5%
Cysteine - 2%

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4
Q

What are the Metabolic Causes of Urinary Tract Calculi?

A

Hypercalciuria
Hyperuricaemia
Hypercystinuria
Hyperoxaluria

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5
Q

What are the infective causes of Urinary Tract Calculi?

A

Hyperuricaemia

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6
Q

What drugs can cause Urinary Tract Calculi?

A

Indinavir

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7
Q

What are the risk factors for Urinary Tract Calculi?

A

Low fluid intake

Structural urinary tract abnormalities (e.g. horseshoe kidney)

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8
Q

What is the epidemiology of Urinary Tract Calculi?

A

COMMON
2-3% of general population
3 x more common in MALES
Age group affected: 20-50 yrs
Bladder stones more common in developing contries
Upper urinary tract stones more common in industrialised countries

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9
Q

What are the presenting symptoms of Urinary Tract Calculi?

A 
Often ASYMPTOMATIC
Severe loin to groin pain
Nausea and vomiting 
Urinary urgency, frequency or retention
Haematuria
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10
Q

What are the signs of Urinary Tract Calculi?

A

Loin to lower abdominal tenderness
No signs of peritonism
Leaking AAA is the main differential to consider in older men
Signs of systemic sepsis if there is an obstruction and infection above the stone

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11
Q

What investigations for Urinary Tract Calculi?

A 
Bloods 
Urine
X-Ray KUB 
Intravenous Urography (IVU)
US 
Non-enhanced Spiral CT 
Isotope Radiography
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12
Q

What bloods do we do for Urinary Tract Calculi?

A

FBC - high WCC if infection
U&Es - check renal function
Calcium
Urate Phosphate

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13
Q

What do we do for Urine for Urinary Tract Calculi?

A

Dipstick - haematuria is common

MC&S

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14
Q

Why do we do X-Ray KUB for Urinary Tract Calculi?

A

80% of kidney stones are radio-opaque

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15
Q

Why do we do Intravenous Urography (IVU) for Urinary Tract Calculi?

A

Allows visualisation of the kidneys and ureters

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16
Q

Why do we do an US for Urinary Tract Calculi?

A

May show hydronephrosis and hydroureter

17
Q

Why do we do Non-enhanced Spiral CT for Urinary Tract Calculi?

A

Can also be used to image stones

18
Q

Why do we do Isotope Radiography for Urinary Tract Calculi?

A

Used to assess kidney function

19
Q

What is the management plan for the Acute Presentation of Urinary Tract Calculi?

A

Analgesia
Bed rest
Fluid replacement
Urine collection to try and retrieve any stone that has passed (most stones < 5 mm will pass spontaneously)

20
Q

How do we manage an obstructed infected kidney?

A

It is an emergency and should be treated as soon as possible to relieve the obstruction (e.g. by placing a percutaneous nephrostomy)

21
Q

How do you remove calculi for Urinary Tract Calculi?

A

Urethroscopy
Extracorporeal Shock-Wave Lithotripsy (ESWL)
Percutaneous Nephrolithotomy (PCNL)

22
Q

How does Urethroscopy help with Urinary Tract Calculi?

A

A scope is passed into the bladder and up the ureter to visualise the stone
It can then be removed by a basket or broken up with a laser
If the stone can’t be removed, a JJ stent should be placed to allow urine drainage

23
Q

How does Extracorporeal Shock-Wave Lithotripsy (ESWL) for Urinary Tract Calculi?

A

Non-invasive
An electromagnetic shockwave is focused onto the calculus to break it up into smaller fragments that can pass spontaneously

24
Q

How does Percutaneous Nephrolithotomy (PCNL) for Urinary Tract Calculi?

A

Performed for large, complex stones (e.g. staghorn calculi)

After making a nephrostomy tract, a nephroscope is inserted, which allows disintegration and removal of stones

25
Q

What is the treatment of cause for Urinary Tract Calculi?

A

Depends on the cause (e.g. parathyroidectomy if hypercalcaemia due to hyperparathyroidism, allopurinol if hyperuricaemia)

26
Q

What advice do you give to someone with Urinary Tract Calculi?

A

Increased oral fluid intake

27
Q

What are the potential complications of the stones in Urinary Tract Calculi?

A

Infection (pyelonephritis)
Septicaemia
Urinary retention

28
Q

What are the potential complications of ureteroscopy for Urinary Tract Calculi?

A

Perforation

False passage

29
Q

What are the potential complications of Lithotripsy for Urinary Tract Calculi?

A

Pain

Haematuria

30
Q

What is the prognosis for patients with Urinary Tract Calculi?

A

GOOD
However, infection of the calculus could lead to irreversible renal scarring
Recurrence of about 50% over 5 yrs

Renal & Urology (18 decks)

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