Urinary Tract Stones Flashcards
What is the lifetime risk of renal stones?
10%
What stones are more common in men?
Most stones are made of calcium oxalate and phosphate, they are more common in men
What type of stones are 2X as common in women than in men. And what % of all renal calculi do they account for?
Mixed infective stones, account for 15 % of calculi.
They are twice as commone in women than men.
What is the ration of renal stone disease in men to women?
2 : 1 (male : female ratio)
What increases the risk of stone recurrence?
an untreated metabolic or structural abnormality predisposes to recurrent stones.
(50% of pts experience rcurrence within 10 yrs)
What conditions does nephrolithiasis increase the risk of?
- End stage kidney disease
- bone disease
- hypertension
- MI
Where are the 3 main sites of calculi causing obstructuion in the renal tract?
1) Pelvic-ureteric junction
2) Pelvic brim
3) Vesico-ureteric junction
what is the peak age of renal calculi presentation?
20-40 yrs
How do renal stones present?
1) Renal Colic
- excrutiating ureteric spasms - loin to groin
- nausea vomiting
- can’t lie still ( this differentiates from peritonitis)
2) Renal Obstruction
(pain in loin worsened by pressure on trigger spot)
3) Obstruction of mid-ureter
- mimics appendicitis
4) Obstruction of lower ureter
- bladder irritability
- pain in scrotum, penile tip or labia majoria
5) Obstruction in bladder or urethra
- pelvic pain
- dysuria
- can’t pass urine
- interrupted flow
6) UTI coexisting
- frequency
- urgency
- dysuria
- nocturia
7) Pyelonephritis
- fever + rigors
- nausea + vomiting
- loin pain
- haematuria
- urinary symptoms (frequency, urgency, dysuria)
8) haematuria
9) Proteinuria (dipstick)
10) sterile pyuria
11) Anuria
What are the examination signs of renal stones?
may be renal angle tenderness especially to percussion if there is retroperitoneal inflammation.
On examination why would there be renal angle tenderness?
if there is retroperitoneal inflammation there may be renal angle tenderness especially to percussion/
What tests are done for renal stones?
Bloods:
- FBC (infection?)
- CRP (inflamm)
- U+Es (creatinine, GFR)
- Ca2+ (raised? —> calcium stones)
- Phosphate (raised? —> bone disease)
- glucose
- bicarbonate (low in renal tubular acidosis)
- serum urate (raised in uric acid stone formers)
URINE DIPSTICK:
-+ve for blood, protein, glucose
MSU:
- blood?
- infection? WBc?
URINE pH
IMAGING:
- non contrast CT
- USS (shows stones in kidney and renal pelvis dilation)
what does a low plasma bicarbonate indicate in renal disease?
renal tubular acidosis
what is the immediate management of renal stones?
Immediate: 1) Analgesia (diclofenac) 2) IV fluids 3) treat infection with Abx e.g IV cefuroxime 4)
Stones that are less than 5mm in the lower ureter can pass spontaneously with increased fluid intake. What is the treatment for stones larger than 5mm with pain that is not resolving.
1) Medical expulsive therapy help to promote expulsion and reduce analgesia requirements.
- nifedipine (10mg)
Or
- alpha blocker (tamsulosin)
2) Shockwave lithotripsy
3) ureteroscopy with basket
4) large stones removed via percutaneous nephrolithotomy
