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Urology/Renal > urolithiasis - stone disease in the urinary tract > Flashcards

urolithiasis - stone disease in the urinary tract Flashcards

(49 cards)

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1
Q

what are the commonest age group in which stones are seen?

A

30-50, unusual in children

males more than females

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2
Q

where are stones of the upper urinary tract?

A

renal stones

ureteric stones

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3
Q

where are stones of the lower urinary tract?

A

bladder
prostatic
urethral

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4
Q

why do people get stones?

A

anatomical factors - both congenital and acquired
urinary factors
infection

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5
Q

give some examples of anatomical factors that influence whether people get stones

A 
congenital: 
spina bifid
horseshoe kidney
duplex kidney 
PUJO -Pelvi-ureteric junction obstruction

acquired:
- obstruction related to previous radiotherapy or previous surgery or stones from before
- trauma to the urinary tract can result in a changed anatomy
- reflux

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6
Q

give examples of urinary factors that can cause stones

A
  • metastable urine ie a stage of saturation of the urine where crystals can form
  • imbalance of stone promotors and inhibitors
  • presence of high levels of calcium, oxalate, urate, cystine
  • dehydration
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7
Q

what substances in the urine are stones made from?

A

oxalate
calcium
urate
cystine

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8
Q

explain the mechanism of stone formation with reference to a theory

A

nucleation theory - states that stones form from crystals in supersaturated urine
so dehydration plays a significant role
solubility point is where the solute and solvent are present in a metastable state as in you naturally have certain stone inhibitors which prevent solutes and solvents from making stones, but when you have supersaturated crystals in urine ie the formation point, this is when you make stones and crystals form due to pH and lack of inhibitors
Kfp - formation point
Ksp - solubility point

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9
Q

what are the most common types of crystals made from?

A

calcium based eg calcium oxalate and calcium phosphate

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10
Q

how do uric acid stones appear on KUB XR?

A

lucent ie not seen

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11
Q

what is another name for infection stones?

A

struvite stones

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12
Q

How do infection stones form?

A

these are potentiated by bacterial infection that hydrolyses urea to ammonium and raises urine pH to alkaline values (eg Proteus, Pseudomonas, Klebsiella, S. aureus and mycoplasma)
struvite crystals form in alkaline urine

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13
Q

what is the cause of cystinuria?

A

Cystinuria is an inherited autosomal recessive disease that is characterized by high concentrations of the amino acid cysteine in the urine, leading to the formation of cystine stones in the kidneys, ureter, and bladder.
Cystinuria is caused by gene mutations which prevent proper reabsorption of basic, or positively charged, amino acids: Cystine, lysine, ornithine, arginine. (COLA) Under normal circumstances, this protein allows certain amino acids, including cystine, to be reabsorbed into the blood from the filtered fluid that will become urine

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14
Q

how can we prevent the formation of stones?

A 
overhydration - 3.5-3L per hour
low ssalt diet 
normal dairy intake 
healthy protein intake 
reduce BMI
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15
Q

why is a low sodium diet needed to prevent the formation of stones?

A

a high sodium diet increases the amount of calcium in the urine

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16
Q

why is a normal amount of protein recommended?

A

eating too much protein increases the level of uric acid so causes uric acid crystals to develop

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17
Q

what happens if you eat too little calcium?

A

oxalate levels build up in the blood

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18
Q

why should a pt reduce their BMI to prevent stone formation?

A

as this reduces uric acid levels in the blood

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19
Q

what are the specific preventative measure for someone who keeps getting uric acid stones?

A

they only form in acid urine, so deacidify urine to pH 7-7.5

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20
Q

what are staghorn calculi?

Study These Flashcards
A

upper urinary tract stones that involve the renal pelvis and extend into at least 2 calyces

21
Q

how do we specifically treat cysteine stones?

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A

overhydration
urine alkalinisation
cysteine binders
genetic counselling (as A. Recessive)

22
Q

what are the symptoms of stones?

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A

asymptomatic
loin pain (unilateral or bilateral)
renal colic - see card on the features of this
UTI symptoms - dysuria. strangury, urgency, frequency
recurrent UTIs
haematuria - visible or non-visible

23
Q

what is renal colic?

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A

pain from upper urinary tract obstruction

24
Q

What are the symptoms caused by renal colic?

Study These Flashcards
A

unilateral/bilateral loin pain
RAPID onset
unable to get comfortable - writhing from pain
radiates to groin and ipsilateral testis/labia
associated nausea and vomiting
colic/spasmodic pain that is worse with fluid loading
severe pain - worse than labour

25
how do we investigate ureteric colic?
``` ABC give analgesia/antiemetic focused history and examination- ask about risk factors and system review urinalysis - MSU - haematuria and leukocytes urine culture FBC U+E calcium uric acid NCCT-KUB as first line KUBXR for monitoring after NCCT-KUB ```
26
what is the ideal painkiller for kidney stones
NSAIDs
27
when may ultrasound be used
can be used for follow up of stones in the kidney ( not good for ureteric stones) useful in pregnancy and younger recurrent stone formers as reduces radiation
28
describe the path of the ureters on KUBXR
along the transverse processes of the spine in line with the sacroileac joint cross the pelvic brim and enter the true pelvis into the bladder
29
what does NCCT KUB stand for?
non-contrast computerised tomography
30
what are the advantages of NCCT-KUB?
very rapid very sensitive and specific no contrast - so don't have to worry about allergies and kidney function
31
what are the disadv of NCCT KUB?
no functional info as no contrast used | radiation
32
what are the disadv of NCCT KUB?
no functional info as no contrast used radiation may not be able to differentiate stones from artefacts caused by previous surgery
33
how should you interpret a NCCT KUB?
count the kidneys look at the condition of the kidneys including the perinephric tissues, cortical thickness, hydronephrosis/hydroueter stones any other pathology
34
what is a scout image?
done before the NCCT-KUB to prescribe CT slices and to display slice locations helps to determine the position of the stone aids decisions for follow up imaging - ie check whether the stone is still there
35
how do we manage ureteric colic?
``` analgaesia - NSAIDs or opiates antiemetics may admit to hosp may give IV fluids observe for sepsis ```
36
what is infection of the kidney's urinary collecting system called?
pyonephrosis
37
what are the complications of pyonephrosis?
can lose renal function in 24 hours systemic sepsis leading to septic shock infected obstructed kidney can kill - sometimes very quickly
38
how is pyonephrosis treated?
IV antibitoics oxygen escalate care drain the infection
39
what are the two methods of drainage of kidneys in pyonephrosis
nephrostomy | ureteric stent
40
What does the method of drainage depend on?
position of stone, size and the symptoms caused and pt factors and local availability
41
what are the 4 treatment categories for stones?
conservative medical lithotripsy surgical
42
what are the complications of kidney stones?
can migrate to the ureter if small larger stones can occlude calyces and/or PUJ can cause acute obstruction- renal or ureteric colic chronci renal damage in infection stones causing abscess nad fistulae xanthogranulomatous pylonephritis - unusual form of chronic pyelonephritis characterised by granulomatous abscess formation, severe kidney destruction
43
how many stones will progress?
1/3
44
How are renal stones managed?
conservative- if the stone is small and asymptomatic ESWL - if the stone is up to 1-2 cm and have problems with passing fragments and clearance of the stone ureteroscopic - lazer PCNL - percutaneous nephrolithotomy - for stones > 2cm, or for several stones nephrectomy if kidney function has declined
45
what is ESWL and what does it stand for?
Extracorporeal Shock Wave Lithotripsy  - it is an external treatment, for stones that are 1-2 cm and we fragment them with X-rays
46
what is PCNL and what does it stand for?
Percutaneous nephrolithotomy - done through the skin and make a 1cm cut in the kidney to remove the stone
47
how do we treat ureteric stones?
conservative - if less than 5mm will pass by themselves drainage if urosepsis ESWL for small stones ureteroscopy - with lazer
48
what is the gold standard for diagnosis of stones?
NCCT-KUB
49
what is the lifetime risk of stones?
10-15%

Urology/Renal (14 decks)

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