Urolithiasis Flashcards
1
Q
Outline the pathogenesis of renal calculus formation
A
- Pro-calculus formation factors
- Increased calcium, urate, oxalate, sodium, urinary pH
- Decreased magnesium, citrate, urinary volume
- Obstruction of the collecting system/ureter and increase in pressure causes the sensation of renal colic
2
Q
What are likely findings on history/exam in a patient with urolithiasis?
A
- Flank pain
- May have radiation to groin
- Previous episodes
- Nausea/vomiting
- Irritative urinary symptoms
- Haematuria
- Dehydration
- Costovertebral angle/flank tenderness
3
Q
What are the main investigations necessary in a patient suspected of urolithasis?
A
- Urinalysis
- FBE (exclude UTI)
- UEC, creatinine, Ca/urate
- KUB + abdo CT
- Pregnancy test (ectopic?)
4
Q
What are the main principles of management of urolithasis?
A
- Analgesia and supportive therapy
- Fluids, morphine, ondansetron
- Expectant therapy if intervention not indicated
- Antibiotic therapy if infection present
- Medical intervention
- Tamulosin (a-blocker) or nifedipine - expulsion therapy
- Surgical intervention
- Lithotripsy, ureteroscopy, stenting
- Prevention
- Dietary modifications (low sodium, urate, high citrate)
5
Q
What are most renal stones made of?
A
Calcium oxalate (70%), which is radio-opaque
6
Q
What might indicate the need for intervention in someone suspected of renal stones?
A
- Infection/sepsis
- Uncontrolled pain
- Prolonged obstruction
- Bilateral obstruction
7
Q
How long does it take for most renal stones to pass?
A
5-7mm stones - up to 3 weeks
8
Q
If a renal obstruction such as a stone causes obstructive pyonephrosis, how might you manage that?
A
IVABs and decompression (nephrostomy/stent) often required
