RENAL - Kidney stones Flashcards Preview

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Flashcards in RENAL - Kidney stones Deck (8)

Types of kidney stones

–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


Risk factors of kidney stones

–Diet (high animal protein & sodium)


Mx of kidney stones

•Pain relief

See if pt needs acute intervention
•Renal Impairment
•Bilateral obstructing calculi
•Solitary kidney (anatomical or functional)
•Inability to control Sx
–Refractory pain (repeat presentations)
•Prolonged obstruction
•Unlikely to pass spontaneously


Describe obstructive polynephrosis
- causative organism
- Mx

•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)


Discuss medical expulsive therapy for kidney stones

α-blockers relax ureteric wall

Tamsulosin 0.4 mg OD x 2/52


Surgical options for kidney stones

•JJ stent and delayed management

•Ureteroscopy and lithotrospsy

•Shock wave lithotripsy


Describe radiolucent stones
- type of stone
- pH of urine
- Rx

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


Prevention of stone recurrence in kidneys

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

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