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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

wylie-holcomb
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Renal Stone Disease

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  1. Renal Stone Disease 2013 Mini-Lecture

  2. 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

  3. Case • 49 year old woman with history of hypertension, 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

  4. 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

  5. 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

  6. 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)

  7. Differential • Differential for flank pain with hematuria • UTI • Renal Cell Carcinoma • Ectopic pregnancy • Dissecting AAA with renal artery involvement

  8. Types of Stones • In order of prevalence • Calcium Oxalate • Calcium Phosphate • Struvite • Urice Acid • Cystine

  9. 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

  10. 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.

  11. 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

  12. 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

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