KIDNEY STONES

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KIDNEY STONES
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Epidemiology

• Affects 5-10 of Americans in their lifetime
• Chance of recurrence is about 50
• Men are more often affected than women
• Average age of onset is between 20 and 30 years.

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Types and their causes

• Calcium oxalate and phosphate
• - Account for about 70 of stones.
• - Causes include hypercalciuria,
• hyperuricosuria, hyperoxaluria, etc
• Magnesium Ammonium Phosphate
• - 15-20 of stones
• - caused by urea-splitting bacteria
  Proteus and some
• Staph
• - Form the Staghorn calculi

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• Uric acid
• - 5-10 of stones
• - Predisposed with gout, leukemias, or ???
• Cystine
• - Only 1-2 of stones
• - Caused by genetic defects in renal
• reabsorption of amino acids.

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Clinical Presentation

• Acute flank pain
• Renal colic if passed into ureter or if
  obstruction
• Urinary urgency or frequency
• Hematuria
• Nausea and vomiting
• Fever and chills
• Silent if large because remain in renal pelvis

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Diagnosis

• History
• Physical
• Urinalysis to look for blood and bacteria, etc

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Diagnosis

• IMAGING STUDIES
• CT Scan
• Noncontrast CT scans are now the modality of
  choice
• Advantages include..
• 1)elimination of contrast
• 2)no need for bowel prep
• 3) can see noncalcified stones
• 4) less expensive than IVP
• 5) does not require experienced radiologic
  technician.

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CT Images of Stones
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Diagnosis cont.

• Intravenous Pyelography
• Classic diagnostic test of choice
• Advantages include..
• 1) Can document nephrolithiasis and upper-tract
  anatomy
• 2) Oblique views can diff between gallstones and
  renal stones on the right.
• Disadvantages include..
• 1) Bowel prep
• 2) Reactions to contrast
• 3) Can take a really long time

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IVP
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Diagnosis cont.

• Abdominal plain film
• Will reveal calculus in up to 80 of cases
• Disadvantages include
• Stones must generally be at least 2mm in
  diameter
• Stones must contain calcium to be visible

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KUB of stones
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Diagnosis cont.

• Ultrasound
• Advantages include.
• Useful if patient is pregnant or has
  contraindication to IVP
• When used with KUB can be as effective as IVP

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Ultrasound of stone
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Treatments

• Analgesia and hydration are most effective
  treatments
• Shockwave lithotripsy for stones lt2cm
• Uteroscopy
• Percutaneous nephrostomy and nephrouterostomy
  catheters to darin obstruction- especially
  important in urosepsis

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PNT placement

• Percutaneous nephrostomy tube is placed by an
  interventional radiologist

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THE END