Renal Calculi

Question 1

What should immediatly be thought of if someone has painless gross hematuria

Answer 1

bladder cancer until proven otherwise

Question 2

What is the most common cause of gross hematuria

Answer 2

BPH

Question 3

If a dipstick is positive for heme and 2+protein, where is the most likely issue

Answer 3

Kidneys

Question 4

What does it mean if the dipstick is positive for epithelial cells

Answer 4

Contaminated specimen

Question 5

What is the difference between glomerular and non-glomerular etiologies

Answer 5

Glomerular: kidney itself
Non- Glomerular: Structural/pathologic condition wisinle on imaging

Question 6

What RBC amount is the qualifying level for a hematuria

Answer 6

over 3

Question 7

What imaging is preformed with gross hematuria

Answer 7

Cystoscopy
CTU/MRU

Question 8

What type of eval/imaging is preformed with intermediate/highrisk hematuria

Answer 8

cystoscopy
cytology not routinely recom.
no role for ultrasound

Question 9

What is the third most common urinary tract disease

Answer 9

nephrolithiasis

Question 10

How do kidney stones form

background causes?

Answer 10

Supersaturation of urine

Dehydration, decreased UPO, increased excretion, disturbance in pH

Question 11

What is the biggest contributing risk factor for kidney stones

Answer 11

Dehydration

Question 12

Where are kidney stones most commonly found

Answer 12

ureteropelvic junction near the iliac artery OR at the ureterovesicular junction

Question 13

What are the 4 main types of kidney stones

Answer 13

Calcium based
uric acid
struvite
cystine

Question 14

What is the most common type of kidney stones

What are the types within this class

Answer 14

Calcium

Calcium oxalate & calcium phosphate

Question 15

What are the traditional risk factors for calcium stones

Answer 15

dehydration
obesity
GI issues
Diuretics
dietary oxalate (rhubarb / spinach)

Question 16

What are the causes of uric acid stones

Risk factors?

Causes?

Answer 16

Monosodium urate, associated with gout and DM

+ family history

fish, shellfish, meat

Question 17

What is struvite

When do these stone occur

What are the characteristics

Answer 17

Magnesium ammonium phosphate

Post UTI typically

fast growing, become staghorn

Question 18

When are cystine stones typically seen

cause?

Answer 18

younger… under 40 y/o

inherited metabolic disorder (cystinuria)

Question 19

What is the presentation of renal calculi

Answer 19

flank pain (CVA radiating to groin)
inability to get comfortable
N/V
Dysuria
inability to urinate
cloudy/foul smelling urine
hematuria

Question 20

What is the biggest PE finding with renal calculi

Answer 20

CVA tenderness

Question 21

If the renal calculi are associated with infection, what interventions need to be done

Answer 21

immediate ureteral stenting
PCN placement

Question 22

What is the gold standard imaging test for renal calculi

first line imaging for stones?

Answer 22

non-con CT

Renal US

Question 23

What size stones can generally pass on their own

What size stone is considered for medical expulsive therapy (MET)

Answer 23

<5mm

<10mm

Question 24

If a patient has renal colic and is not pregnant, what is the only approved medication that can be used

What is the standard tx for renal colic

Answer 24

Metoclopramide

Hydration, pain control, anti-emetic

Question 25

When is surgical intervention required with kidney stones and what does it entail

Answer 25

stones>10mm

extracorpporeal shock wave lithotripsy (ESWL) or ureteroscopy

Question 26

If a patient has an infection along with a confirmed kidney stone and obstruction, how do you treat

Answer 26

treat with Gentamycin x14days before stone removal can occur

Question 27

What is the best prevention for renal calculi

Answer 27

Increased fluid intake