Renal Cases

Question 1

Most common sxs associated with nephro/ureterolithiasis?

Answer 1

Pain (flank radiating to groin so renal colic)
Hematuria (microscopic or gross)
*may see passing stone or gravel, n/v, dysuira or urgency

Question 2

Why do kidney stones occur?

Answer 2

Supersaturation of the urine leading to crystal formation

Question 3

Types of stones

Answer 3

Calcium oxalate and calcium phosphate (most common)
Struvite (Mg ammonium phosphate)
Uric acid (radiolucent and cannot be seen)
Cystine

Question 4

Risk factors for nephrolithiasis

Answer 4

Hx of prior one (especially within 5 yrs)
FH stone
Decreased fluids
Malabsorption (increase urinary oxalate excretion)
Hyperparathyroidism, HTN, DM, obesity, gout, excessive running

Question 5

Preferred imaging technique for nephrolithiasis

Answer 5

Non-contrast low radiation CT of abd and pelvis

• detect stones and obstruction
• IV contrast decreases sensitivity for small stones

Question 6

Other imaging for nephrolithiasis

Answer 6

US (no radiation but less sensitive, might still need CT after)
Abd xray (miss uric acid stones, doesn’t show obstruction)
Intravenous pyelogram not usually recommended

Question 7

What size stones usually pass spontaneously?

Answer 7

<5 mm

Question 8

Tx for nephrolithiasis

Answer 8

Pain meds: NSAIDs or opiates
Hydrate
Strain urine for several days
Facilitate passage (alpha blockers like tamsulosin .4 mg QD to relax smooth muscle around urinary tract)

Question 9

When do you refer to urology?

Answer 9

Stone > 10 mm
Failure to pass without conservative management
Significant obstruction (avoid scarring/damage)
Urgent: infection, AKI, anuria, unyielding pain, n/v

Question 10

Types of surgeries of nephrolithiasis

Answer 10

Shock wave lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy

Question 11

Pt education for nephrolithiasis

Answer 11

Increased hydration and decrease Na intake
Consider allopurinol if gout
Consider hydrochlorothiazide (stimulate Ca reabsorption in kidney, reduce Ca in urine)

Question 12

What is associated with an increased risk of renal cell carcinoma?

Answer 12

Smoking (male more)

Question 13

Presentation of renal cell carcinoma

Answer 13

Many are asymptomatic til advance

Triad: hematuria, flank pain, palpable abdominal mass

Question 14

How to diagnose renal cell carcinoma

Answer 14

CT abdomen or pelvis
US
Might accidentally find mass for something else
Tissue

Question 15

Management for renal cell carcinoma

Answer 15

Localized: nephrectomy

Disseminated disease: varied options