Flashcards in Lesson 4B (Part 4) Deck (28)
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1
Nephrolithiasis
Renal calculi
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Who is more affected by nephrolithiasis?
Caucasian men with increasing age
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What are nephrolithiasis composed of?
Calcium
- 60-80%
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What are predisposing conditions of nephrolithiasis? (5)
1. Dehydration
2. Urinary stasis
3. Hyperuricemia
4. Hyperparathyroidism
5. Hypercalciuria
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What is the cause of nephrolithiasis?
No cause
- if not obstructed its usually asymptomatic
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Where can migrating calculus cause? (2)
1. Infundibular
2. UPJ obstruction
- stones may pass into the ureter and lodge in three areas of ureteric narrowing
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What are symptoms of calculi?
Flank pain
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What percent do stones <5mm pass spontaneously?
80%
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What percent of patients have flank pain due to calculi?
77-93%
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What are the 3 areas of ureteric narrowing?
1. UPJ just past the ureteropelvic junction
2. Where the ureter crosses the iliac vessels
3. UVJ at the ureterovesicular junction
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What accounts of ureteric narrowing?
Small diameter (1-5mm) of UVJ
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What are the modalities that can identify calculi? (5)
1. Plain x-ray films
2. Tomography
3. Intravenous urography
4. Ultrasound
- high sensitivity ***
5. Unenhanced CT
- used if US is unable to detect size and location of stones in patients with severe pain or cant see due to gas
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What are the sonographic findings of calculi?
Echogenic foci with sharp distal acoustic shadowing
- twinkle artifact
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What percent of stones have the twinkling artifact?
83%
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What are other possibilities that can mimic calculi? (5)
1. Intrarenal gas
2. Renal artery calcification
3. Sloughed papilla
4. Pyelitis
5. Ureteric stent
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What do you want tin order to see a twinkle artifact?
A high PRF
- high gain
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What might be hard to see due to bowel gas and deep retroperitoneal position?
Ureteral calculi
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Hydroureter
A dilated ureter will be seen as a tubular hypoechoic structure entering the bladder obliquely
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What may be seen on either side of the stone?
Anechoic ureter
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What does obstructing ureteral calculus cause?
Hydronephrosis of the collecting system
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What happens with hydronephrosis of collecting system?
Urine is being produced but cannot flow from the kidney to the bladder
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What can hydronephrosis be confused with?
Multiple parapelvic cysts
- which would not connect to the pelvis
- they need to be connected
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What are the S/S of hydronephrosis? (4)
1. Flank pain
2. Hematuria
3. Fever
4. Leukocytosis
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What could potentially cause hydronephrosis? (8)
1. Stasis of urine
2. Infection
3. Tumor extension from the bladder, ureter or kidney
4. Thrombus
5. A kink in the UPJ
6. An enlarged prostate gland in men
- which can be due to BPH or prostatitis
7. Pregnancy
- causes a compression due to a growing fetus
8. A narrowing of the ureter from an injury or birth defect
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What is grade 1 hydronephrosis?
Small fluid filled separation of renal pelvis
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What is grade 2 hydronephrosis?
Dilation of some but not all calyces
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What is grade 3 hydronephrosis?
Marked dilatation of renal pelvis and all calyces
- an echogenic line separates the collecting system from the parenchyma
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