Case-Kidney stone

Question 1

Management for Kindey stone

Answer 1

Pain control

HYDRATION

Question 2

What is 1st line pain control?

Answer 2

NSAIDS (Toradol= Ketorlac)

Question 3

When would we give opioids?

Answer 3

-Don’t respond to NSAIDs
-Intolerant of NSAIDs (contraindications)
-Severe renal disease
“DIS”

Question 4

Stone passage:

≤__mm usually pass spontaneously

Answer 4

5

Question 5

Stone Passage:

≥__ mm, probably won’t pass spontaneously

Answer 5

10

Question 6

Stone size range when we use medical expulsion therapy

Answer 6

5-10mm

Question 7

1st line medical expulsion therapy?

How long?

Answer 7

Tamsulosin (Flomax) alpha 1 blocker

up to 4wks

Question 8

Other options for medical expulsion therapy?

Answer 8

CCB (nifedipine) non-dipines
Tadalafil (PDE5 inhibitor)
= vasodilators
“CT

Question 9

Indications for inpatient admission for kidney stone

Answer 9

• Fever
• Uncontrollable pain
• NPO= Inability to tolerate PO
  “Kidney stones are no FUN”

Question 10

Indications for Urology consult in admitted kidney stone

Answer 10

• Pain (unyielding)
• Anuria
• Stone present >4wks
• Concurrent UTI
• AKI
• N/V (unyielding)
  “PA SCAN”

Question 11

Supportive measures for admitted kidney stone

Answer 11

• Treat Sx
• Obs
• Alpha blocker (if stone b/w 5-10mm)
• Strain urine

“TOASt”

Question 12

T/F? Patients should strain their urine and bring in any stone that passes for analysis

Answer 12

True

Question 13

MC type of stone

Answer 13

Calcium Oxalate

Question 14

Struvite Stones only form in the presence of _____ producing ______

Answer 14

Urease, Bacteria
=
- Proteus mirabili
- Ureaplasma urealyticum
- Corynebacterium species
- Klebsiella pneumoniae

Question 15

What imaging modality is 1st line?

Answer 15

CT A/P w/o

• Can see hydronephrosis
• HIGHEST accuracy for NEPHROLITHIASIS

Question 16

What can you see on UA?

Answer 16

Hematuria

Question 17

T/F? You cannot see hydronephrosis on KUB U/S

Answer 17

False

Question 18

Other types of stones?

Answer 18

• Calcium Phosphate
• Uric acid
• Struvite

Question 19

What can you see on PE for nephrolithiasis?

Answer 19

CVA tenderness

Question 20

T/F? BUN:Cr ↑ for nephrolithiasis

Answer 20

True, but not aggressively

Question 21

T/F? Stone recurrence is probable after 1st episode?

Answer 21

True

Question 22

When to perform

Surgery?

Answer 22

Stones >12mm

Question 23

What kind of surgery is performed to remove stones?

Answer 23

Lithotripsy

Question 24

T/F: Ultrasound of kidneys and bladder can show hydronephrosis

Answer 24

True

Question 25

T/F: 1st line imaging for kindey stone is u/s of kidneys & bladder

Answer 25

False. U/S is 2nd line

CT A/P w/o contrast is 1st line

Question 26

Do we order a CT A/P with or w/o contrast 1st line?

Answer 26

CT A/P without contrast