Download kidney stones - JCSC Wellness Challenge

Ashish R. Parekh, MD
Urologic Surgery
Kaiser Permanente, WLA
* Men>Women (4:1 ratio)
* Age 20-50
* Prior stone former 10x more likely to get
another stone in his lifetime
* Hereditary
* Medullary sponge kidney, hyperoxaluria,
cystinuria, renal tubular acidosis (RTA)
* Dehydration
* Excessive salt
* Excessive oxalates
* Medications
* Indinavir, Guifenesin, topirimate, diuretics
* Medical problems
* Hyperparathyroidism, gout, intestinal
malabsorption, laxative abuse, obesity, diabetes,
recurrent urinary tract infections
* Fad diets
*
* Normal urine pH is 5.5-6.5
* The kidneys filter EXCESS minerals (potassium,
calcium, phosphorus, etc) and metabolites
(oxalates, uric acid) from the blood
* When the pH is TOO HIGH (alkaline) or TOO
LOW (acidic) AND there is TOO MUCH
mineral/metabolite, STONES FORM IN THE
KIDNEY, just like in a test tube in chemistry
class; it’s a concentration/crystallization
problem!
*
* Earliest stone: Egyptian mummy, 4500-5000 BC
* Earliest stone surgery (literary documentation):
Sushruta performed a perineal lithotomy, India, ~6th
century BC
* Documented in Sushruta Samhita
* Modern day surgery:
* 1800s: perineal lithotomy (bladder stone removal)
* 1900s: percutaneous stone removal, ESWL,
ureteroscopy
*
* Pain in the upper back (SEVERE), either the
LEFT or RIGHT side
* Blood in urine
* Fevers, nausea, vomiting
DO NOT IGNORE THESE SYMPTOMS!!
*
* Proper history FROM THE PATIENT
* Hydration, control of pain, nausea, vomiting
* Urine and blood tests
* Imaging test (plain Xray, CT scan or ultrasound)
* Antibiotics are OPTIONAL, but life-saving if
there is sign of infection
* Urology referral
*
* Pain medication
* NSAIDs are best
* Narcotics in case of severe pain
* Medication to help pass the stone
* Tamsulosin
* FOLLOWUP IMAGING TO PROVE STONE HAS PASSED!
* Instructions on how to PREVENT future stones
* Hydration, less salt, less animal protein, add lemon
juice to your water
*
*
* EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY
* Least invasive
* German-engineering at its finest!
* URETEROSCOPY WITH LASER LITHOTRIPSY
* Endoscopic (no “cutting”)
* PERCUTANEOUS NEPHROLITHOTOMY
* Small hole in your back
*
URETEOSCOPY, LASER LITHOTRIPSY
PERCUTANEOUS NEPHROLITHOTOMY
* MOST stones pass (especially if <7mm) without
surgery
* ONLY uric acid stones can be dissolved
* Stones can cause kidney failure, if causing a
blockage
* Stones are possible even if you have NO PAIN
* Kidney stones are COMPLETELY different than
gallstones
* Catch your stone, so we can analyze and give
recommendations
*
*
Calcium Oxalate
Stone
types
Calcium Phosphate
(60-70%)
Uric Acid (10-15%)
Struvite (10-15%)