RENAL - Kidney stones Flashcards

1
Q

Types of kidney stones

A

–Calcium oxalate (70%)
–Uric acid (radio-lucent)
–Magnesium ammonium phosphate (struvite/infection stones)
–Cystine (cystinuria- autosomal recessive disorder)
–Other: matrix, proteases inhibitor stones (radiolucent)

90% are radio-opaque

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2
Q

Risk factors of kidney stones

A

–Dehydration

–Diet (high animal protein & sodium)

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3
Q

Mx of kidney stones

A
•Pain relief
–NSAIDS
–Opioids
–Paracetamol
•Hydration
See if pt needs acute intervention 
•Infection/Sepsis
•Renal Impairment
•Bilateral obstructing calculi
•Solitary kidney (anatomical or functional)
•Inability to control Sx
–Refractory pain (repeat presentations)
•Prolonged obstruction
•Unlikely to pass spontaneously
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4
Q

Describe obstructive polynephrosis

  • causative organism
  • Mx
A
  • Urological emergency
  • Usually GNB (E.Coli)
  • High rates of SIRS/shock

–IV Abs (G-ve AND Enterococcus coverage)
–Urgent decompression (nephrostomy, stent)
–Supportive care (fluids, monitoring, ICU if necessary)

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5
Q

Discuss medical expulsive therapy for kidney stones

A

α-blockers relax ureteric wall

Tamsulosin 0.4 mg OD x 2/52

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6
Q

Surgical options for kidney stones

A

•JJ stent and delayed management

•Ureteroscopy and lithotrospsy
–Laser
–Pneumatic

•Shock wave lithotripsy
–ESWL

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7
Q

Describe radiolucent stones

  • type of stone
  • pH of urine
  • Rx
A

Usually uric acid (or cystine)

Form in acidic urine (pH less than 6.0)

Dissolve with urinary alkalinisation
–Target pH > 6.5
–Potassium citrate / sodium bicarbonate
–Allopurinol if serum uric acid levels elevated

High fluid intake

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8
Q

Prevention of stone recurrence in kidneys

A
•Adequate fluid intake
•Dietary modification
•Urinary alkalinization
•Medical therapy
–Allopurinol
–Thiazide diuretics
•Cystinuria
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