Condition- Urinary Tract Caliculi

Question 1

What is nephrolithiasis?

Answer 1

Presence of crystalline stones (calculi) within the urinary system

Question 2

State the three sites along the urinary tract where stones often deposit

Answer 2

1. pelviureteric junction
2. pelvic brim (over iliac blood vessels)
3. vesicoureteric junction

Question 3

What is the usual composition of urinary tract calculi? List some of the other types of stones too

Answer 3

Calcium oxalate

Struvite - quite common

Urate - 5%

Hydroxyapatite (5%)

Cysteine - 2%

Question 4

List some of the causes of urinary tract caliculi…

Answer 4

• IDIOPATHIC
• Metabolic- hypercalciuria, hyperuricaemia, hypercystinuria, hyperoxaluria, hyperparathyroidism, renal tubular acidosis
• Infection- recurrent UTIs
• Drugs- indinavir, diuretics, antacids, corticosteroids
• Urinary tract abnormalitis- juction obstruction, hydronephrosis, uteral
• Foreign bodies- catheter, stent

Question 5

List some risk factors leading to the development of nephrolithiasis…

Answer 5

• Dehydration + warm climate
• Diet:
  
  • High salt
  • High protein
  • High oxalate: chocolate, rhubarb, spinach etc
• Kidney disease: polycystic/ medullay sponge, renal tubular acidosis
• Hypercalciuria, hyperPTH, hypercalcaemia
• Gout, ileostomy=> urate stones

Question 6

Which gender are kidney stones more common in?

Answer 6

MALES

Question 7

Describe the pain produced by urinary tract calculi

Answer 7

Severe loin to groin

Question 8

Recall the symptoms of urinary tract calculi

Answer 8

• SEVERE loin to groin pain – renal colic
• Nausea and vomiting
• Unable to lie still
• Urinary symptoms: urgency, frequency or retention, haematuria

Question 9

What is the main differential to consider in suspected urinary tract calculi when the patient is an elderly man?

Answer 9

Leaking AAA

Question 10

If a patient with kidney stones develops tachcardia, hypotension and a fever- what complciation might they have?

Answer 10

Urosepsis

Question 11

What is the first line investigation for someone with kidney stones?

Answer 11

Urinalysis- check for haematouria, leukocytes, nitrates

Question 12

What is the gold standard investigations for identiying the presence of urinary calculi?

Answer 12

Non-contrast helical CT- calcification seen in renal collecting system or ureter

Question 13

In a female patient with lower groin pain- which differential must you exlcude and how?

Answer 13

Ectopic pregnancy and conduct a pregnancy test

Question 14

What blood tests outside of the usual would you order in urinary tract calculi?

Answer 14

Calcium
Phosphate
Urate

(+ U&Es and renal function- could check PTH)

Question 15

What % of urinary tract calculi are radio-opaque?

Answer 15

80%

Question 16

Stones of what size in the urinary tract will pass spontaneously?

Answer 16

<5mm

Question 17

What would make a urinary tract stone an acute presentation?

Answer 17

Obstructed or infected kidney

Question 18

How would you manage a patient acutely presenting with nephrolithiasis?

Answer 18

• Analgesia: diclofenac 75mg PR
• Bed rest
• Fluid replacement: IV if unable to withstand PO
• Urine collection: to collect stones
• Abx: cefuroxime or gentamicin IV

Question 19

List some medications and procedures to expel/ remove calculi

Answer 19

• MEDICATIONS:
  
  • nifedipine
  • a-blockers (tamsulosin)
• PROCEDURES
  
  • ESWL= Extracorporeal shock wave lithotripsy (EM waves)
  • Urethroscopy + basket removal/stent insertion
  • Percutaneous Nephrolithotomy= keyhole surgery