Nephrolithiasis Kidney Stones

• History / PE:
  Severe, colicky flank pain that may radiate to the testes or vulva
  Nausea and vomiting
  Hematuria
• Diagnosis:
  Noncontrast CT abdomen (gold standard)
  KUB only identifies radiopaque stones
  Renal U/S
• Treatment:
  IVF HYDRATION ( > 2L/day)
  Analgesia
  Decreased dietary protein, oxalate, and sodium
  Increased dietary calcium
  
  Stones < 5 mm can pass through the urethra
  Stones < 3 cm can be treated with ESWL, percutaneous nephrolithotomy, or retrograde ureteroscopy
  
• Notes:
  Calcium oxalate stones (rectangular, envelope shaped)
  
  75-85% of kidney stones
  Small bowel disease, surgical resection, chronic diarrhea
  Also from FA malabsorption (calcium binds to FA in GI tract and oxalate gets reabsorbed)
  Seen in ethylene gylcol (antifreeze) poisoning
  
  Calcium phosphate stones
  Seen in primary hyperparathyroidism and RTA
  
  Struvite stones (MgNH4PO4)
  Urease-producing oragnisms (Proteus, Pseudomonas, Providencia, Klebsiella)
  Look for history of recurrent UTIs
  Form staghorn calculi
  
  Uric acid stones
  
  Associated with gout and chemo txs
  Radiolucent (KUB will miss)
  Put patients on low protein diet
  Treat with potassium citrate
  
  Cystine stones ( cystinuria )
  
  Hexagonal crystals
  Increased excretion of cysteine
  Inborn errors of metabolism