Stones Flashcards
(17 cards)
Give an example of a rare cause of stones
Cystinuria (familial)
List possible composition of stones
CaOx (80%) CaP Uric acid Cysteine Indinavir Infection MAP (magnesium ammonium phosphate) / Struvite
What is the presentation of stones?
Pain
Renal colic
Give some other differentials for similar presentation
AAA Biliary colic Constipation Bowel obstruction Ectopic pregnancy
What can be used to confirm diagnosis of stones
Haematuria on dipstick good indication
CT KUB
What blood are important in diagnosing stones?
U&Es
Calcium
Urate
What is the role of RBC in urine?
Good positive indicator, not a good negative indicator
What is the gold standard imaging for stones?
CT KUB
What is the initial management for stones?
Analgesia - NSAIDs +/- opiates
What are some instances where a patient with stones should be admitted?
Single kidney Pyrexia Continuing pain Renal impairment Pregnancy Large stones/severe obstruction on CT
What are the conservative treatment options for stones?
Wait for it to pass naturally
What are the medical options for treatment of stones?
Tamsulosin
Alpha blocker, blocks receptors in ureter to help with spontaneous passing
What are the other treatment options for stones?
ESWL (extracorporeal shock wave lithotripsy)
Ureteroscopy
PCNL (percutaneous nephrolithotomy)
What general advice is given to patients with stones?
High fluid intake (2.5 - 3L/day)
Do not cut out dairy to reduce calcium, but don’t take supplements
Less salt
Less animal protein, especially red meat
When should a patient with stones return to A&E?
If pain does not settle
Pyrexi
What are some complications of renal stones?
Infection, including life-threatening gram -ve sepsis
Renal damage
What are some causes of recurrent renal stones?
Underlying metabolic problems (hyperparathyroidism, gout, cysteinuria)
Underlying anatomical problems (PUJ-O, medullary sponge kidney, horseshoe kidney, ureteric stricture)
Majority are idiopathic
