Renal Tract Stones

1
Renal Tract Stones

• Angelika Na

2
Renal tract stones

• 10 of Caucasian men by age 70
• Recurrence
• 10 in 1 year, 50 in 10 year
• Risk factors
• Age 20-50
• Male, genetics (RTA, cystinuria)
• Summer
• Water intake
• Diet
• Occupation

3
Renal tract stones

• Composition
• Calcium oxalate (85 of all renal calculi)
• HyperCa eg. hyperPTH, Pagets dx
• Uric acid (5-10)
• Gout, myeloproliferative disorder
• Calcium phosphate calcium oxalate (10)
• RTA
• Calcium phosphate (rare)
• Struvite (infection stones - 2-20)
• Cystine (1)
• Cystinuria

4
Renal tract stones

• XR
• Radio-opaque
• Calcium phosphate, calcium oxalate
• Radiolucent
• Relative - cystine (sulphur), struvite
• Complete - uric acid, triamterene, xanthine,
  indinavir
• Size shape
• Staghorn calculi

5
Kidney stones

• Pain, haematuria
• UTIs (staghorn, struvite)
• Pyonephrosis, perinephric abscess, septic,
  pyelonephritis
• Flank pain

6
Kidney stones - Mx

• Watchful waiting
• lt5 mm (20), 5-10mm (25), 11-15 mm (40), gt15 mm
  (30) will require intervention
• ESWL
• lt1 cm (80), 1-2 cm (60), gt2 cm (50) stone free
  rates.
• Flexible ureteroscopy laser
• lt2 cm (80), gt2 cm (50) 10 pt require gt2tx
• PCNL lithotripsy
• 80-90 stone free rates.
• Open surgery (nephrolithotomy)
• Medical mx

7
Ureteric stones - Clinical

• Renal colic - loin to groin
• Uncomfortable, doubled-up with pain, nv
• Fever - BC, IV fluids Abx, nephrostomy
• Pregnancy test
• Dipstick MSU
• FBE, UEC, Ca, Uric acid

8
Differential Diagnosis

• AAA
• Pyelonephritis
• Appendicitis
• Ovarian pathology
• Biliary pathology

9
Ureteric stones - Radiology

• CT KUB
• XR KUB -? radioopaque
• (IVP)
• MR KUB

10
XR KUB
11
CT KUB
12
Ureteric stones - Mx acute

• Analgesia - NSAID, opiate
• Fluid
• Watchful waiting - stone size
• lt4 mm - 90 pass spontaneously
• 4-6 mm - 50
• gt6 mm - 20
• Medical mx - tamsulosin

13
Ureteric stones - Surgical mx

• Indications
• Pain, bacteriuria, fever, impaired Cr, prolonged
  unrelieved obstruction, social
• Solitary kidney, bilateral stones
• Temporary relief of the obstruction
• Percutaneous nephrostomy
• JJ stent - SE bladder irritation

14
Ureteric stones - Surgical mx

• Definitive mx
• (position of stones)
• Ureteroscopy
• ESWL (? JJ stent)
• PCNL
• Ureterolithotomy (open, lap)
• Percutaneous antegrade ureteroscopy

15
Bladder stones

• Composition
• Struvite (infection), uric acid
• Age
• Men gt 50yo, BPH
• Long term IDC / SPC
• Children - low phosphate diet
• Clinical
• Asymptomatic (sc patients) - XR, US
• Haematuria, urgency, UTIs, LUTS
• Mx
• Cystolitholapaxy (endoscopic, open)

16
Renal tract stones

• Treat underlying cause
• Hyperparathyroidism - parathyroidectomy
• Hyperuricosuria - allopurinol urine
  alkalinisation
• Homocysteinuria - D-penicillamine
• Prevention
• Fluid intake
• Calcium
• Proteins
• Wine
• Oxalate