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
3
What are nephrolithiasis composed of?
Calcium
- 60-80%
4
What are predisposing conditions of nephrolithiasis? (5)
1. Dehydration
2. Urinary stasis
3. Hyperuricemia
4. Hyperparathyroidism
5. Hypercalciuria
5
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
13
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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