Nephrology - Kidney Stones

5 major stone compositions

Calcium oxalate

Calcium phosphate

Struvite

Uric acid

Cystine

Are kidney stones MC in males or females?

males

MC site of kidney stone

VUJ (UVJ)

Term for stone anywhere in urinary tract

urolithiasis

Term for Stone in kidney

nephrolithiasis

Term for Stone in ureter

ureterolithiasis

MC kidney stones composition?

Calcium oxalate

MC and most preventable RF

dehydration

Signs/Symptoms of kidney stones?

1. Abrupt onset of severe flank pain +/- radiation to groin

2. Dysuria, frequency

3. N/V

4. writhing in pain...not sitting still

DDx of stones that is life threatening

AAA rupture

What should be performed on all recovered stones

• Stone Analysis (give them a strainer!)

What might you see on the UA for kidney stones?

hematuria and abnormal pH

pH greater than 7.5 and KS makes you think of....

struvite from infection

What serum tests should you order for recurrent*** kidney stones?

BMP

Uric acid

PTH

Gold standard diagnostic test?

CT (non-contrast)

aka ''stone hunt''

KS: Name a few diagnostic tests

o KUB→Shows 85% of stones

o Abdominal US

o Spiral CT (non-contrast) **

o IVP

When might you order abd US for stones?

pregnant

children

What medication can be used to prevent Ca stones?

***Thiazide diuretics: **

• Do NOT Restrict Dietary Calcium!

How would you dx cystine stones?

radiolucent ... so need CT

Preventative medication for uric acid stones

allopurinol

• Stones less than ___ mm usually pass spontaneously...

5

Name some procedures for stone removal

Lithotripsy

ureteroscopy

percutaneous extraction

MC organism with struvite stone

proteus --- bacterial infection

ph w/ struvate stone

alkaline / basic / high

Which stones are more likely to pass, upper or lower tract stones?

lower

Ca oxalate crystal shape

envelope

Struvite crystal shape

coffin lid

Uric acid crystal shape

rhomboid

Cysteine crystal shape

hexagonal

Two major complications of stones

pyelo

hydronephrosis