Nephro-urolithiasis (Kidney Stones) Flashcards
List the common types of stones in order of most common.
Calcium Oxalate - 45%
Calcium Oxalate & Phosphate - 25%
Triple Phosphate - 20% (infective)
Uric Acid - 5%
Cystine - 3%
Calcium Phosphate - 3%
What is a staghorn stone?
One that involves the renal pelvis and calyces
Describe the gender differences in stones?
Men are 3x more likely
Men peak in their 30s
Women peak at 35 & 55
Presentation of stones?
PAIN DEPENDS ON LOCATION OF STONE:
Renal pain - fixed in loin
Ureteric colic - pain originating in flank and radiating to groin
Testicular/Vulval pain
OTHERS: Dysuria, haematuria UTIs Loin tenderness Pyrexia
Also stones can cause frequency and sudden interruption of streams
What baseline investigations can you do?
Bloods:
- FBC
- Us an Es
- creatinine
- Ca, Albumin, Urate
- PTH
Urine analysis, culture and 24 hr urine collections
What radiological investigations can you do?
X-Ray of KUB (Kidney-ureter-bladder)
Ultrasound scans
Intravenous urograms (not really used anymore)
CT-KUB
What are the indications for surgical treatment?
Obstruction
Recurrent gross haematuria, pain and infections
Loss of kidney functions
Types of surgery ?
Open
PCNL - Percutaneous Nephrolithotomy
ESWL - Extracorporeal Shock Wave Lithotripsy
Endoscopic
When would you use ESWL?
ESWL is the first line treatment for most urinary stones.
Except those >2cm or Lower tract stones
When would you use Endoscopic treatments?
For bladder stones
Or higher if theres uncontrollable pain, severe obstruction, persistant haematuria or failed ESWL
When would you use PCNL?
IF the stones are ESWL resistant such as cystine stones
What are the types of open stone removal?
Partial Nephrectomy - removes part of the kidney
Simple nephrectomy - removes the whole kidney
Total nephrectomy - removes the kidney, suprarenal gland and surrounding tissue
When do you do open surgery?
IF a large stone –> Infection and non-function necessitates kidney removal
Or ESWL/PCNL aren’t available
