LU 3 : Urolithiasis & Tumor

What is urolithiasis ?

• This condition involves the formation of calcifications in the urinary system

• hard objects, made up of millions of tiny crystals.

Explain the pathophysiology of urolithiasis ?

• Presence of stones anywhere in the urinary tract

• Most commonly found in the renal pelvis and calyces

• Stones forming in the kidney – nephrolithiasis

• Stones formed in the ureters – ureterolithiasis

What are the type of kidney stones ?

• calcium stones : calcium oxalate stones (more common) and calcium phosphate stones

• uric acid stones : form when urine is too acidic

• struvite stones (infection stones) : form after UTI

• cystine stones

What are the sign and symptoms of urolithiasis ?

• sharp pain in your back

• pain at lower abdomen

• bloody urine

• pain at groin area

• pain at side of body

What are the complications of urolithiasis ?

• hematuria

• severe pain

• UTI

• loss of kidney function

What are the diagnosis test for urolithiasis ?

• Lab tests : urinalysis, blood tests

• Imaging test : abdominal x-ray, CT scan

What are the treatment for urolithiasis ?

• Kidney stone removal : percutaneous nephrolithotomy (PCNL) for larger stones

• Lithotripsy : breaking up kidney stones using ultrasound eg : Extracorporeal shock wave lithotripsy (ESWL)

• medications :

• i) analgesics such as NSAIDs

• ii) antibiotics : to treat UTI

• iii) diuretics : help prevent calcium stones from forming

• iv) IV fluids : help patient to stay hydrated

What is kidney tumor ?

a mass or group of abnormal cells that form on your kidney

What are the sign and symptoms for kidney tumor ?

• blood in urine

• flank pain

• pain in lower back

• loss of appetite

• unexplained weight loss

• fever

• high blood pressure

What are the risk factors of kidney tumor ?

• older age

• smoking

• high blood pressure

• family history of kidney cancer

What are the diagnosis test for kidney tumor ?

• Imaging tests : CT scan, MRI scan

• Urinalysis

• Renal mass biopsy

What are the treatment for kidney tumor ?

• surgery : i) partial nephrectomy ii) radical nephrectomy

• ablation therapy : i) cryoablation ii) radiofrequency ablation

• radiation therapy

• drug therapy

• chemotherapy

What are the types of kidney cancer ?

• Renal cell carcinoma (RCC) : clear cell renal cell carcinoma (ccRCC) most common

• Transitional cell carcinoma : begins in renal pelvis

• Renal sarcoma : least common form and begins in connective tissues of kidneys

• Renal medullary carcinoma

Where does clear cell renal cell carcinoma (ccRCC) spreads to ?

• lymph nodes

• lungs

• adrenal glands

• liver

• brain

• bones

What are the stages of kidney cancer ?

• Stage I : i) tumour is 7cm across or smaller and only in kidney.

• Stage II : tumor is larger than 7cm across but still in kidney

• Stage III : tumour spread to major blood vessels such as renal vein and inferior vena cava

• Stage IV : tumour spread outside kidney to adrenal gland or other organs

What are the side effects of chemotherapy ?

• Hair loss

• mouth sores

• nausea and vomiting

• loss of appetite

• increased chance of infections

• easily bruised

What are the pre-operative care in hand for AVF ?

• Dont use the hand for blood draws or IV drugs

• Dont use for taking blood pressure or any surgical procedure

• Surgeon may ask for duplex ultrasound

• Dont insert peripheral IV catheter

What are the post-operative care of AVF or AVG?

• check radial pulse, colour, movement and warmth of affected limb

• assess the access patency : palpate for thrill or listen for bruits

• monitor blood pressure and hydration status : to prevent access clotting

• elevate the access arm to minimize edema

What are the patient education for AVF ?

• check thrill at least once daily

• avoid tight clothing

• avoid carrying heavy objects

• avoid exposure to extreme heat or cold

• avoid checking BP on access arm

• wash the access arm with soap and water pre-dialysis

• absence of thrill must be reported to the renal unit