Renal and Ureteral Stones

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Renal and Ureteral Stones
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• Urologic stone disease has an estimated incidence
  of 12.
• 3 times more common in males and in 2nd-5th
  decade of life
• More common in mountainous, desert, or tropical
  regions. Also more common in warmest months.
• Children lt16 comprise 7 of those with renal
  stones with a 11 sex distribution.
• Up to 1/3 of patients have a recurrence w/in 1
  yr.
• Appears to be a familial component

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• Most stones contain calcium and are radiopaque
  and can be caused by chronic hypercalcemic states
• Hyperthyroidism
• Hyperparathyroidism
• Neoplasm
• Sarcoidosis
• Multiple Myeloma
• Distal Renal tubular acidosis

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• Struvite stones are radiopaque and cause 15 of
  stones. They are caused by chronic UTI and
  assoc. with urea-splitting organisms (Proteus).
• Cystine stone (1-3) are radiopaque and are
  hereditary
• Uric acid stones account for 6-10 and are
  radiolucent. Seen in pts with
• Gout
• Myeloproliferative disease and leukemia
• High protein diet

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• Xantine stones are radiopaque and rare, cause
  unknown.
• Clinical presentation includes unilateral colicky
  pain in the flank, back, lower abd quadrant with
  radiation to the groin. Pain improves as stone
  falls into the bladder. Vomiting may occur as
  pain increases.
• Dont forget to rule out other life threatening
  problems (AAA)
• Stones lt5mm usually pass on their own

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• 90 of stones are radiopaque and may be seen on
  KUB or IVP. Stones can be seen over the
  transverse process of lumbar vertebrae.
• Radiolucent stones are seen as filling defects on
  IVP
• Pts with stones should at some point have a serum
  calcium performed to r/o primary
  hyperparathyroidism.

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• Labs and Radiographic studies may include
• U/A
• Hematuria is typical with stones but 20 of pts
  will not have micro hematuria
• A urinary Ph of gt7.6 suggest urea splitting
  organisms and a Ph of lt7.4 suggests uric acid
  calculi andn rules out RTA

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• Urine culture if suspected infection
• BUN/Cr prior it IV dye
• Serum Ca, Phos, and uric acid levels
• Pregnancy test in females
• CT scanning is now diagnostic study of choice
  gt98 sensitivity, faster, and no IV contrast
• Lucent and radiopaque stones are visible
• Other abnormalities may be seen

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• IVP
• Reserved for situations where a functional or
  anatomic study is required
• It is occasionally therapeutic d/t hyperosmolar
  contrast load-increase urine output-passage of
  stone
• Findings of suspected stone include
• Delayed nephrogram on the affected side
• Hydronephrosis/hydroureter
• Columnization (visualization of the entire ureter
  on a single film
• Extravasation of contrast

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• Ultrasound is the study of choice in pregnant and
  peds patients.
• Treatment-IV hydration with NS (2ml/kg/hr of
  urine output)
• Toradol and narcotics are the DOC for pain
  relief. The meds act together reducing the need
  for higher doses of narcotics.

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• Bladder stone are usually associated with bladder
  foreign bodies, bladder outlet obstruction or
  infection.
• Most common in males over 50 y/o.
• Most commonly composed of calcium oxalate.
• Emergency therapy is needed in urinary
  obstruction of with associated infection.

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• Dispostion of patients home should be instructed
  to
• Increase fluid intake
• Strain urine
• Urology F/U
• Return if persistent vomiting, fever, chills or
  constant pain

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• Admission should be considered
• Presence of UTI
• Uncontrolled pain
• Intractable N/V
• Renal insufficiency

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