Nephro - Kidney stones - Online MedEd Flashcards Preview

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Flashcards in Nephro - Kidney stones - Online MedEd Deck (17):
1

Presentation kidney stone

Colicky flank pain radiate to groin
Hematuria
Without fever or mass usually
-Pain is due to peristalsis in ureter on kidney stone

2

What is first step in work up of kidney stone?

Urinalysis - no microscopic hematuria, probably not a stone
Usually microscopic hematuria with stone

3

What is next step of kidney stone after U/A

Non-con CT scan is best
Also options for US and KUB
-If have to pick one, pick non-con CT (gold standard)
-Look for stone itself (radio-opaque) or look for hydronephrosis
-US not great for stones
-Pregnancy cannot do non-con CT
-Do US in pregnancy
-KUB can be used to track resolution of stone, not as great as CT
-If non-con CT shows no hydro or stone --> likely something else
-If it does show either hydro or stone --> it is kidney stone

4

Remember what sizes of stone

<5mm
>3cm

5

<5mm stones

IVF to flush out stone
Pain meds

6

>3cm stones

Surgery

7

In between the sizes of 5mm and 3cm is what treatment option

Lithotripsy - patient in tub, use US waves pound on flank, pass through urethra
Lithotripsy for proximal stones
Ureteroscopy for distal stones - put a camera into the ureter to look at it
-So stones in between - break it up

8

Also less than 7mm do what?

IVF and pain meds, also medical expulsive therapy
-Do something to get stone out --> CCB (amlodipine) or alpha-blocker (tamsulosin/BPH meds)

9

>1.5 cm stone what to do?

Surgery
Proximal - laparoscopic surgery (not open)
Distal - PAN (percutaneous anterograde nephrolithotomy

10

Septic - what to do?

Put in a nephrostomy tube (proximal)
Stent for distal stone

11

What does the patient need to do post-treatment?

Strain urine
To determine the type of stone, to modify the risk factors

12

When does patient need to return

in 6 weeks for screen

13

Types of stones are...

If have lots of volume, will decrease likelihood of stone formation
1) Calcium oxalate (most common)
2) Struvite
3) Uric acid stones
4) Cysteric stones

14

Calcium oxalate stones

Most common 85%
Radio-opaque
Increased Ca and increased oxalate in urine
Treatment: give thiazide diuretics
Decrease oxalate (red meet), increase citrate (veggies and fruits)

15

Struvite stones

Magnesium, ammonium, phosphate
Radio-opaque
Caused by UTIs (proteus - urea splitting activity)
Manage aggressively
Staghorn stones - all in kidney and don't pass on own
-Need surgery to remove all stone burden

16

Uric acid stones

Radiolucent
Caused by gout, tumour lysis
Can modify risk factor: allopurinol, and use rasburicase (for tumour lysis)

17

Cysteric stones

Radiolucent
Genetic
Won't see on exam