Renal stones

Question 1

stone composition

Answer 1

calcium oxalate
calcium phosphate
uric acid
struvite
cysteine

Question 2

why do bladder stones occur

Answer 2

urinary stasis (men-bladder outflow obstruction)
foreign bodies eg. if been investigated for bladder sx and something left in by accident

Question 3

RF urinary stones

Answer 3

anatomical anomay
HTN
gout
hyperparathyroid
calc/vit d supplements
dehydration

Question 4

describe renal colic pain

Answer 4

• sudden severe pain. -starting in loin at costoverterbal angle, moves to groin with tenderness of loin/renal angle
• radiates to testis, scrotum, labia, anterior thigh

Question 5

renal colic vs biliary/intestinal colic

Answer 5

whereas pain of biliary/intestinal colic is intermittent pain of renal colic is more constant. may be peirodis of relief or dull ache before it returns

Question 6

symptoms along with pain

Answer 6

rigors/fever
dysuria
haematuria
urinary retention
n+v

Question 7

exam

Answer 7

-pt w/ colic writhes in agony (peritoneal irritation lies still)
apyrexial (pyrexia suggests infection, usually v high w pyelonephritis)
-may have tenderness over affected loin
-severe pain in testis but testis not tender

Question 8

ddx

Answer 8

aaa!!!!!!!!!!!!!!!!!!!!!
acute appendicitis
ectopic
biliary colic
t torsion

Question 9

ix

Answer 9

urinalysis - red cells suggestive of urolithiasis, wcc/nitrate suggestive of infection

ph: ph <5 suggests uric acid stones
- CT image of choice
- x-ray KUB may show stones
- stone analysis

Question 10

stone analysis for who

Answer 10

first stone, recurrent stones on preventative meds, early recurrence, late recurrence

Question 11

when is rx inpatient?

Answer 11

• one kidney
• inadequate pain relief
• dehydration
• anuria
• preg
• ? ddx
• poor social support
• can’t arrange urgent outpatient f/u

Question 12

initial rx

Answer 12

• diclofenac IM or PR! (nsaids for effective than opioids, less likely to cause nausea
• opioids may be required if severe/to cover time taken for NSAID to work
• antiemetics, rehydration therapy
• most pass sponatenously (take 1-3 weeks)
• medical expulsion therapy may be used - nifedipine or tamulosin

Question 13

rx at home (after initial rx)

Answer 13

lots of fluids
para or cocodamol
radiology outpatient appointment

Question 14

rx options if stone does not pass spontaneously

Answer 14

• extracorporeal shock wave lithotripsy (ESWL). shock waves over stone to break it apart. parts then pass.
• percutaneous nephrolithomy (PCNL) stones >2cm. stones removed using a nephroscope
• ureteroscopy. laser breaks up stone
• open surgery (rare)

Question 15

complications

Answer 15

• complete block of urinary flow decreased GFR. can cause irreversible renal damage
• infection (lifethreatening)

Question 16

prevention

Answer 16

increase fluid intake to maintain urine output at 2-3 L / day

• reduce salt intake
• less meat
• cranburry juice
• normal calcium
• meds to prevent further stone formation depending on stone formation

Question 17

med for stone for a) calc stones, b) uric acid stones c) oxalate stones

Answer 17

a) thiazide diuretics
b) allopurinol
c) calcium citrate