Urinary tract calculi Flashcards
Define urinary tract calculi
Crystal deposition within the urinary tract (AKA nephrolithiasis)
Aetiology of urinary tract calculi (4)
Idiopathic
Metabolic
Infection
Drugs
Aetiology of urinary tract calculi - metabolic
4
Hypercalciuria
Hyperuricaemia
Hypercystinuria
Hyperoxaluria
Aetiology of urinary tract calculi - infection
1
Hyperuricaemia
Aetiology of urinary tract calculi - drugs
1
Indinavir
Types of stone
4
Calcium oxalate - most common
Struvite - quite common
Urate - 5%
Cysteine - 2%
Epidemiology of urinary tract calculi
prevalence, gender, age, location x2
COMMON (2-3% pop)
3x more common in males
Affects 20-50 yr olds
Bladder stones more common in developing countries, upper urinary tract stones more common in industrialised
Presenting symptoms of urinary tract calculi
1 + 4
Often ASYMPTOMATIC
SEVERE loin to groin pain
N&V
Urinary urgency, frequency or retention
Haematuria
Signs of urinary tract calculi on physical examination
3 + differential
Loin to groin lower abdominal tenderness
NO signs of peritonism
Signs of systemic sepsis if there’s an obstruction & infection above the stone
Leaking AAA is main differential to consider in older men
Investigations for urinary tract calculi
7
Bloods Urine Xray KUB IVU (IV urography) US Non enhance spiral CT Isotope radiography
Investigations for urinary tract calculi - bloods
5
FBC - high WCC if infection U&Es - check renal function Calcium Urate Phosphate
Investigations for urinary tract calculi - urine
2
Dipstick - haematuria is common
MC&S
Investigations for urinary tract calculi - X-ray KUB
80% kidney stones are radio-opaque
Investigations for urinary tract calculi - IVU
Allows visualisation of kidneys & ureters
Investigations for urinary tract calculi - US
May show hydronephrosis & hydroureter
Investigations for urinary tract calculi - non enhanced spiral CT
Can also be used to image stones
Investigations for urinary tract calculi - isotope radiography
Used to assess kidney function
Branches of management of urinary tract calculi
4
Acute presentation
Removal of calculi
Treatment of cause
Advice
Management of urinary tract calculi - acute presentation
5
Analgesia
Bed rest
Fluid replacement
Urine collection to try & retrieve any stone that has passed
An obstructed, infected kidney is an emergency & should be treated ASAP to relieve obstruction
Management of urinary tract calculi - removal of calculi
3
Urethroscopy
Extracorporeal shock wave lithotripsy
Percutaneous nephrolithotomy
Management of urinary tract calculi - treatment of cause
3
Depends on cause
Parathyroidectomy if hypercalcaemia due to hyperparathyroidism
Allopurinol if hyperuricaemia
Management of urinary tract calculi - advice
1
Increase oral fluid intake
Complications can arise from…
3
Stones
Ureteroscopy
Lithotripsy
Complications of stones
3
Infection - PYLONEPHRITIS
Septicaemia
Urinary retention
Complications of ureteroscopy
2
Perforation
False passage
Complications of lithotripsy
2
Pain
Haematuria
Prognosis of urinary tract calculi
general, problem, recurrence
GOOD
Infection of calculus can lead to irreversible renal scarring
Recurrence about 50% over 5 yrs
