Week 109 Haematuria and renal colic

Question 1

Calcium Stones

Answer 1

70%

Oxalate- spiky

Phosphate- Smooth

Dehydration
Hypercalcaemia

Question 2

Infection related stones

Answer 2

15-20%

Struvite (magnesium Ammonium Phosphate)

Infection converts urea to ammonia. Alkaline environment causes precipitations

Large stones and staghorn calculi

Question 3

Uric Acid Stones

Answer 3

5-10%

Hyperuricaemia causes 50%

Low urinary pH

Question 4

Cysteine stones

Answer 4

1-2%

Genetic defects in renal reabsorption of amino acids

Question 5

Bladder stones

Answer 5

Usually men relating to outflow problems

Question 6

3 sites of stones lodging

Answer 6

PUJ -Pelvi-Ureteric junction
Pelvic brim
VUJ- Vesico-Ureteric junction

Question 7

kidney/ureteric stones presentation

Answer 7

Loin to groin colicky pain.
restless and writhing
N&V

Question 8

Stones in bladder presentation

Answer 8

Pain at end of microturition
referred pain to end of penis
Pain worse on sharp movements

Question 9

Investigations for stones

Answer 9

Urine dipstick- haematuria (white cells + nitrites)

Urine cultures

Bloods- FBC & CRP

U&Es- creatinine and renal function

Bone profile- Check Ca2 and PO4

CT Urogram

Bladder US

Question 10

management of stones

Answer 10

conservative- up to 3 weeks monitoring

NSAIDS eg diclofenac
opiods can be added but not pethidine

High fluid intake

medical expulsive therapy- Nifedipine or tamsulosin

Question 11

admit if…….

Answer 11

fever
inadequate pain control
anuria
Dehydration/inability to take fluids

Question 12

Non invasive treatments

Answer 12

Extracorporeal Shock Wave Lithotripsy- for stones up to 2cm

Question 13

Surgical intervention

Answer 13

large stones >6mm
infected/obstructed kidney
stone not passed in 1-2 months
staghorn calculi
signs of renal failure

percutaneous nephrolithotomy (above 2cm)

Retrograde uteteroscopy up to 1cm