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Renal Tract Stones
Angelika Na
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Renal tract stonesRenal tract stones
10% of Caucasian men by age 70 Recurrence
10% in 1 year, 50% in 10 year Risk factors
Age 20-50 Male, genetics (RTA, cystinuria) Summer Water intake Diet Occupation
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Renal tract stonesRenal tract stones
Composition Calcium oxalate (85% of all renal calculi) HyperCa eg. hyperPTH, Paget’s dx
Uric acid (5-10%) Gout, myeloproliferative disorder
Calcium phosphate + calcium oxalate (10%) RTA
Calcium phosphate (rare) Struvite (infection stones - 2-20%) Cystine (1%)
Cystinuria
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Renal tract stonesRenal tract stones
XR Radio-opaque
Calcium phosphate, calcium oxalate
Radiolucent Relative - cystine (sulphur), struvite
Complete - uric acid, triamterene, xanthine, indinavir
Size & shape Staghorn calculi
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Kidney stonesKidney stones
Pain, haematuria UTIs (staghorn, struvite) Pyonephrosis, perinephric abscess, septic, pyelonephritis
Flank pain
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Kidney stones - MxKidney stones - Mx Watchful waiting
<5 mm (20%), 5-10mm (25%), 11-15 mm (40%), >15 mm (30%) will require intervention
ESWL <1 cm (80%), 1-2 cm (60%), >2 cm (50%) stone free rates.
Flexible ureteroscopy + laser <2 cm (80%), >2 cm (50%); 10% pt require >2tx
PCNL + lithotripsy 80-90% stone free rates.
Open surgery (nephrolithotomy) Medical mx
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Ureteric stones - Clinical
Ureteric stones - Clinical
Renal colic - loin to groin Uncomfortable, doubled-up with pain, n&v
Fever - BC, IV fluids + Abx, nephrostomy
Pregnancy test Dipstick + MSU FBE, UEC, Ca, Uric acid
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Differential DiagnosisDifferential Diagnosis AAA Pyelonephritis Appendicitis Ovarian pathology Biliary pathology
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Ureteric stones - Radiology
Ureteric stones - Radiology
CT KUB XR KUB -? radioopaque (IVP) MR KUB
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XR KUBXR KUB
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CT KUBCT KUB
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Ureteric stones - Mx acute
Ureteric stones - Mx acute
Analgesia - NSAID, opiate Fluid Watchful waiting - stone size <4 mm - 90% pass spontaneously
4-6 mm - 50% >6 mm - 20%
Medical mx - tamsulosin
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Ureteric stones - Surgical mx
Ureteric stones - Surgical mx
Indications Pain, bacteriuria, fever, impaired Cr, prolonged unrelieved obstruction, social
Solitary kidney, bilateral stones
Temporary relief of the obstruction Percutaneous nephrostomy JJ stent - SE: bladder irritation
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Ureteric stones - Surgical mx
Ureteric stones - Surgical mx
Definitive mx(position of stones) Ureteroscopy ESWL ( JJ stent) PCNL Ureterolithotomy (open, lap) Percutaneous antegrade ureteroscopy
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Bladder stonesBladder stones Composition
Struvite (infection), uric acid Age
Men > 50yo, BPH Long term IDC / SPC Children - low phosphate diet
Clinical Asymptomatic (sc patients) - XR, US Haematuria, urgency, UTIs, LUTS
Mx Cystolitholapaxy (endoscopic, open)
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Renal tract stonesRenal tract stones
Treat underlying cause- Hyperparathyroidism - parathyroidectomy
- Hyperuricosuria - allopurinol + urine alkalinisation
- Homocysteinuria - D-penicillamine Prevention
Fluid intake Calcium Proteins Wine Oxalate