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KIDNEY STONES

KIDNEY STONES. 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. Types and their causes. Calcium oxalate and phosphate:

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KIDNEY STONES

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  1. KIDNEY STONES

  2. 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.

  3. 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

  4. 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.

  5. 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

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

  7. 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.

  8. CT Images of Stones

  9. 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

  10. IVP

  11. 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

  12. KUB of stones

  13. 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

  14. Ultrasound of stone

  15. Treatments • Analgesia and hydration are most effective treatments • Shockwave lithotripsy for stones <2cm • Uteroscopy • Percutaneous nephrostomy and nephrouterostomy catheters to darin obstruction- especially important in urosepsis

  16. Percutaneous nephrostomy tube is placed by an interventional radiologist PNT placement

  17. THE END

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