Nephrolithiasis Kidney Stones

Nephrolithiasis
  • 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



Review Edit Entry New Entry


August 5th 2010