Renal stones Flashcards
What are the 3 areas that kidney stones are normally deposited?
- Pelviureteric junction
- Pelvic brim
- Vesicoureteric junction
1) What is the commonest subtype of kidney stone?
2) Can it be seen on xray?
3) What are the 2 key risk factors for developing this type of kidney stone?
4) What are the 2 subtypes of these kidney stones?
5) Of these 2 subtypes, which is the most common?
1) Calcium based
2) No - it’s radiolucent
3) Hypercalcaemia, low urine output
4) Calcium oxalate, calcium phosphate
5) Calcium oxalate
What are the 3 other types of renal stones?
- Struvite stones
- Cystine stones
- Uric acid stones
1) Which of these is produced by bacteria, therefore, associated with infection?
2) Which of these is not visible on x-ray?
3) Which of these is associated with cystinuria, an autosomal recessive disease?
1) Struvite stones
2) Uric acid stones
3) Cystine stones
1) What is a staghorn calculus?
2) This occurs most commonly in what kind of kidney stone?
1) When the stone forms in the shape of the renal pelvis, giving it a similar appearance to the antlers of a deer stag
2) Struvite stones
What is the presenting complaint in symptomatic kidney stones?
Renal colic
What is renal colic?
Unilateral loin to groin pain that can be excruciating. Colicky (fluctuating in severity) as the stone moves and settles
Name 2 other symptoms of renal stones
- Haematuria
- Nausea or vomiting
- Reduced urine output
- Symptoms of sepsis, if infection is present
1) What does a urine dipstick often show in renal stones?
2) What is normally the investigation of choice to diagnose renal stones?
3) Name something else that may be used in the diagnosis?
1) Haematuria
2) Non-contrast CT of the kidneys, ureters and bladder
3) Abdominal x-ray, blood test
1) What is the most effective type of analgesia in renal stones?
2) Name 2 other drugs/drug groups that may be used, and why they’re used
1) NSAIDs - i.e. PR/IM diclofenac
2) Antiemetics - nausea. Antibiotics if infection. Tamsulosin (alpha-blocker) aid spontaneous passage of stones
Name 2 measures that can be taken to reduce the chance of stone recurrence
- Increase oral fluid intake
- Add fresh lemon juice to water
- Avoid carbonated drinks
- Reduce dietary salt intake
- Maintain a normal calcium intake
- Reduce the intake of oxalate-rich foods (spinach, beetroot, nuts) for calcium stones
- Reduce the intake of purine-rich foods (kidney, liver, anchovies, sardines and spinach) for uric acid stones
What medication can be used to reduce the risk of recurrence of calcium stones?
Thiazide diuretics (indapamide)
How are patients with obstructive urinary calculi and signs of infection managed (2)?
Urgent renal decompression and IV antibiotics
How is a stone burden of less than 2cm in aggregate managed?
Lithotripsy
How is a stone burden of less than 2cm in pregnant women managed?
Ureteroscopy
