Renal stones

Question 1

Prevalence of Urolothiasis

Answer 1

10% caucasian men. 50% recurrence in 10yrs. 1 in 10 people.

Question 2

Intrinsic factors/non-modifiable risk factors

Answer 2

Age
Sex M>F
Testosterone increases oxalate
Oestrogen = inhibits oxalate production
Genetics - cystinuria

Question 3

Other modifiable risk factors for urolothiasis

Answer 3

Hot environment, animal protein, increased salt.
Summer (ureteric stones).
Dehydration
Gout

Question 4

Definition of Nephrolithiasis + Urolithiasis

Answer 4

Neprolithiasis = renal stones formed within kidneys.
Urolithiasis = stones exit renal pelvis + move into rest of urinary collecting system (ureters,bladder, urethra).

Question 5

Most common composition of stones

Answer 5

CaOx = calcium oxalate crystals.

Question 6

Clinical presentation

Answer 6

Renal colic pain
Vomiting and Nausea
Sepsis
Dysuria
Recurrent UTI

Question 7

Inital Ix (bloods)

Answer 7

Serum creatinine + electrolytes
Urine dipstick + culture
FBC/CRP: infection
Calcium/ urate : underlying causes

Question 8

CT KUB - when should it be performed?

Answer 8

• within 14hr of admission
• Pt w fever, solitary kidney
• Diagnosis uncertain.

Question 9

Prevention of calcium

Answer 9

1. High fluid intake
2. Low animal protein
3. Thiazide diuretic

Question 10

Prevention of uric acid stones

Answer 10

• allopurinol
• oral bicarbonates - urinary alkalinzation

Question 11

Other passmedicine risk factors

Answer 11

Renal Tubular Acidosis
Cystinuria
Hypercalciuria
Hyperparathyroidism
Hypercalcaemia

Question 12

When do you intervene w a patient w stones

Answer 12

Pain : increasing size
Obstruction (Urethra)

Question 13

Stone blocking the kidneys w signs of infections. What TX would you do?

Answer 13

1.Nephrostomy Tube
2. Stent

Question 14

For renal stone <5mm. how to treat.

Answer 14

• Lithotripsy - shock waves, cracks stone into tiny pieces
  *Uresterscopy + laser -> smaller pieces easier to pass.