Stones Flashcards
What are stones
Calculi
Nephrolithiasis
Crystal aggregates
Where do stones form
Collecting ducts
Where are the classic spots where they get stuck
Pelviureteric junction
Pelvic brim
Vesicoureteric junction
Types of stones
Calcium oxalate Magnesium ammonium phosphate (struvate) Rate Hydroxyapatite Brushite Cystine Mixed
Presentation
Pain - v bad Spasms - renal colic, loin to groin, Infection - UTI, pyelonephritis, if obstruction inc infection risk Haematuria Proteinuria Sterile pyuria Anuria
Exam
No pain on palpation
Renal angle tenderness on percussion if retroperitoneal inflammation
Tests
FBC U AND E Ca2+ PO43- Glucose Bicarbonate Urate Urine pH 24 hr urine for calcium, oxalate, orate, citrate, sodium creatinine, stone biochemistry - when it’s passed Imaging- non contrast ct kub X-ray , us in hydronephrosis, hydroureter
Treatment
Analgesia diclofenac or opioids IV fluids if can’t PO fluids Infection treat pip/taz or gentamicin <5mm or in lower ureter wait to pass >5mm or pain not resolving - medical expulsion Nifedipine or alpha blocker tamsulosin Surgical Extra corporeal shock wave lithotripsy Ureteroscopy Percutaneous lithotripsy
She is urgent intervention needed
Infection and obstruction May need nephrostomy or stent Urosepsis One working kidney Bilateral stones AKI
How to prevent stones
Drink plenty
Normal calcium diet
Low calcium inc oxalate secretion
What to do with calcium stones
Hypercalciuria
Thiazides diuretic to dec calcium secretion
What to do with oxalate stones
Dec oxalate intake
Pyridoxine vitamin B6
Struvate phospaphate mineral what to do with these stones
Treat infection promptly
Urate crystals what to do
Allopurinol
Urine alkinisation may help as it ales urate more soluble at <6pH
What to do with cystine crystals
Vigorous hydration to keep urine output >3L a day
Urinary alkalisation
Penicillamine to chelate cystine
Give with pyridoxine to prevent b6 deficiency
