Renal Stone Disease
Download
Report
Transcript Renal Stone Disease
Renal Stone Disease
2013
MINI-LECTURE
Objectives
Identify common risk factors for renal stone disease
Identify common signs and symptoms for renal
stone disease
Know the common types of renal stones
Familiarize with basics of renal stone management,
including knowing when to consult urology
Case
49 year old woman with history of hypertension,
diabetes presents with four day history of right sided
flank pain and “pink urine.” What is the most
appropriate imaging to diagnose this patient with
renal stone disease?
A: KUB
B: Ultrasound
C: Contrast-enhanced CT
D: Non-Contrast CT
Etiology
Supersaturation of urine with solutes
Solubility is affected by urine pH, volume and total
excretion
Those factors can often be modified with
medications and diet
Risk Factors
Male sex
Obesity
Family History
H/o stone disease (1/2 will have recurrence)
Dietary factors
Lower fluid intake, higher animal protein, higher Vitamin C
Medical factors
Signs/Symptoms
Typical symptoms
Sudden onset
Unilateral colicky flank pain radiating to groin (localization of
pain evolves as stone migrates)
Often with nausea/vomiting
Hematuria (microscopic or gross)
Differential
Differential for flank pain with hematuria
UTI
Renal Cell Carcinoma
Ectopic pregnancy
Dissecting AAA with renal artery involvement
Types of Stones
In order of prevalence
Calcium Oxalate
Calcium Phosphate
Struvite
Urice Acid
Cystine
Workup
Urinalysis: may show
Hematuria (90% sensitive)
Signs of infection
Crystals
Elevated pH (urea-splitting bugs?) or low pH (RTA?)
Metabolic workup: Consider only if recurrent
Workup
Imaging
Non-Contrast helical CT with Stone protocol is the gold std
(can detect stones not visible by KUB/IVP and has significantly
better sensitivity/specificity)
Ultrasound: For patients needing avoidance of radiation
(pregnant, childbearing age)
IVP: No longer favored due to lower sensitivity, HIGHER
radiation exposure
KUB: Will miss radiolucent uric acid stones, small stones,
stones with overlying bony structures.
Treatment
Urologic Intervention?
X<5mm : most pass spontaneously. Possible observation and
pain control
X>5mm : less than 20% chance of passage and may need
urologic intervention
So when to consult urology?
If > 5mm
For ANY size with ….
Urosepsis, AKI, anuria, unyielding N/V/Pain -> Inpatient consult
Failed conservative management and stone did not pass
spontaneously -> Inpatient or Outpatient consult depending on
severity
Summary
Identified common risk factors for renal stone
disease
Identified common signs and symptoms for renal
stone disease
Know the common types of renal stones
Familiarized with basics of renal stone management,
including knowing when to consult urology