Urology 1: stones Flashcards
how would renal calculi present
sudden sharp loin to groin pain
constant or colic
may be unable to sit still from pain
Hx of previous stones
frequency or other urinary symptoms
UTI symptoms
what could you find on examination of a patient with renal colic
may have illiac fossa pain on balloting the kidneys
temperature if there is associated infection
may want to examine the testicles or external orifices to rule out hernia
what is the most important differential diagnosis to consider for renal stones
ruptured AAA
especially if >60
what are some differentials to consider for renal stones
pancreatitis
biliary colic
appendicitis
gynae pathology
hernia - when it compresses nerves can radiate to the loin
what bedside tests could you consider when suspecting renal stones
urinalysis - erythrocytes, leukocytes, and nitrites
negative dipstick doesnt exclude diagnosis
also want to dip for b-HCG
post void bladder scan
what bloods would you want to request for suspected renal stones
FBC
Us&Es
Bone profile - Ca
Uric acid/ urate
(can cosider LFT and amylase if diagnosis unclear)
eGFR may be normal if unilateral stone
what imaging would be appropriate to request
XR abdominal
CT KUB
what can be done as initial management for renal stones
NSAID- diclofenac PR
opiate as required
tamsulosin can be used for stones in the distal third
monitor pain and signs of sepsis
why does the inital pain of renal stones sometimes decrease naturally
often improves as there is reduced urine output from the affected kidney
and pyelo-venous and pyelo-lymphatic shunting
what is infective obstructive nephropathy
when there is complete blockage by the stone, infection builds up behind and kidney function decreases
may have signs of sepsis
urological emergency
what are the complications of infective obstructive nephropathy
irreversible loss of renal function
worsening sepsis
multi-organ failure
death
how is infective obstructive nephropathy managed
emergency decompression
either with cytoscopy and retrograde JJ stent insertion
or percutaneous nephrostomy
if they have a low base line function in that kidney nephrotomy may be considered
what is a urostomy
ileal conduit
connects ureters from just above the bladder to the external
what is conserative management for renal stones
generally done if stone is under 5mm
give 3-4 weeks for stone to pass
follow up XR to assess movement
ensure adequate analgesia, and advise to stay hydrated
what is EWSL
extracorporeal shock wave lithotripsy
stone must be radio-opaque for this treatment option
can be used for medium sized stones, as wont be able to break up large stones quickly
what could you use to treat larger renal stones
PCNL- percutanous nephrolithotomy
uses a ‘drill’ to break up stone
through a hole in the kidney
apart from ESWL what could you use for definitive treatment mid range size renal stones
ridgid ureteroscopy and laser lithotripsy
when would you observe before surgical intervention of renal stones
if minimally symptomatic or >5mm
which type of renal stone is linked to hyperparathyroidism
calcium phosphate
which is the most common renal stone
calcium oxalate
what are risk factors for forming urate stones
obestity
type 2 diabetes
metabolic syndrome
forms in acidic urine (can check on dipstick)
radiolucent on XR
what type of stone is linked to UTI, and the causative organism
triple phosphate stones (form staghorm caliculi)
proteus miribalis (urea splitting organism)
what are two types of rare stones
cystine stones
indinarvir stones
what is long term management for those who have recurrent issues with kidney stones
check Ca and PTH levels
advise 2-3 litres of water a day
avoid excessive salt/red meat
citrate is beneficial (lemon, apple juice)
maintain normal calcium
