Renal/Ureteric Colic Flashcards
(24 cards)
What is renal/ureteric colic?
Acute and severe loin pain caused when a urinary stone moves from the kidney or obstructs the flow of urine
What are the symptoms and signs of renal/ureteric colic?
- Loin to groin pain which is severe and colicky
- Nausea and vomiting
- LUTS (if stone in lower ureter)
- Occasional Haematuria
- Tachycardia
- Dehydration
- Tender Flank
What causes renal/ureteric colic?
- Metabolic (50%)
- Urological (20%)
- Infection (15%)
- Immobilisation (5%)
What are the metabolic causes of renal/ureteric colic?
- Type 1 Renal tubular acidosis
- Hyperparathyroidism
- Cystinuria
- Sarcoidosis
- Crohn’s disease
What are the differentials for renal/ureteric colic?
- Urological: Pyelonephritis
- Gynae: ectopic pregnancy, torted ovarian cyst
- Gastro: appendicitis, diverticulitis
- Vascular: ruptured AAA
- Misc: Musculo-skeletal pain
Where are the most common places for ureteric stones?
- PUJ
- Crossing iliac vessels
- VUK
How would you investigate renal/ureteric stones?
- FBC
- U+Es
- Ca2+
- CRP
- Urine dipstick
- bHCG
- Non-contrast CT KUB or USS
What is the general management of renal/ureteric stones?
- Analgesia
- Hydration
What is the management of stones ≤5mm?
- Watchful waiting
- Followed up by imaging in 2 weeks
When is tamsulosin considered as a treatment for stone passage?
<10mm
What is the management of stones >5mm?
Shockwave lithotripsy (SWL) or ureteroscopy (URS)
When would you prescribe potassium citrate as a follow-up medication?
- Children and young people with recurrent stones which are >50% calcium oxalate and have hypercalcuria or hypercituria
- Adults with recurrent stones which are >50% calcium ocalate
When would you prescribe a thiazide diuretic as a follow-up medication?
Adults with recurrent stones which are >50% calcium oxalate and have hypercalciuria, after restricting Na+ intake to <6g/day
What are the complications of a stone?
- Pyonephrosis
- Solitary functioning kidney/unilateral stones
- Intractable pain
What is pyonephrosis?
Infected urine behind an obstructing ureteric stone
How is pyonephrosis investigated and managed?
- US
- Nephrostomy tube insertion
What are the types of renal/ureteric stone in order from most-least common?
- Calcium oxalate (65-80%)
- Calcium phospate (10-15%)
- Struvite (10-15%)
- Uric acid (5-10%)
- Cystine (1%)
What stones are opaque on a XR?
- Calcium oxalate
- Calcium phosphate
Which stones are translucent on a XR?
Uric acid
What predisposes patients to calcium oxalate stones?
- Primary hyperoxaluria
- IBD
- Bowel resection
What predisposes patients to calcium phosphate stones?
- Primary hyperparathyroidism
- Renal tubular acidosis
What predisposes patients to struvite stones?
- UTIs with organisms that produce urease enzymes
- Catheters
What predisposes patients to Uric acid stones?
- Obesity
- DM
- High purinergic intake
- Gout
- Tumour lysis after chemotherapy
Which types of stone can cause staghorns?
Struvite
