Kindey Stones

Question 1

Miss L is a 40 year old female woman who presents with a history of severe abdominal pain, radiating from the flank to the groin, nausea and vomiting.

Question 2

What is your first line investigation?

Answer 2

Kidney stone. Not pyelonephritis because no fever. Non-contrast CT.

Question 3

You order a non-contrast CT scan because it is the gold standard for diagnosing kidney stones. What does this CT show?

Answer 3

Kidney stone in the pelvis of the right kidney.

Question 4

Which diuretic could be used to help prevent kidney stones?

Answer 4

Thiazide like diuretics. Increase reabsorption of calcium which reduces it in the urine.

Question 5

Her stone is 4mm. The doctor prescribes analgesia and encourages an intake in fluids to pass the stone. If it was larger, what would you recommend?

Answer 5

• Shock wave therapy (ESWL)
• Open surgical removal
• Endoscopic removal of the stone

Question 6

The patient has a nephrostomy because she has hydronephrosis in her right ureter. Using this model, explain how hydronephrosis occurs.

Answer 6

Urine backs up into the kidney due to the blockage of the kidney stone. This dilates the kidney and causes it to swell. This puts pressure on the kidney and damages the tissue.