Download 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,
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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