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Classic Kidney stone presentation - CORRECT ANSWER: acute onset of severe,
colicky flank pain that wax and wane in intensity.
Severe pain is associated with the movement of the stone and can cause n/v.
pt may seem anxious and unable to sit still
,history and physical for nephrolithiasis (kidney stones) - CORRECT ANSWER: Irritative
Bladder symptoms -dysuria (painful or difficulty urinating), urgency, & frequency
Vague flank pain or acute colicky pain with increasing intensity
Radiation of pain into the groin
Costovertebral angle (CVA) tenderness
Hematuria
Diaphoretic, tachycardic, appear extremely uncomfortable
CVA tenderness tell your the stone is located where? - CORRECT ANSWER: caused by
passing of the stone through the ureter with obstruction & spasm
Where is the stone located if the patient has pain in the groin region? - CORRECT
ANSWER: pain that radiates downward into the groin indicates the stone has passed
into the lower third of the ureter
Vague flank pain or acute colicky pain with increasing intensity means the stone is
located where? - CORRECT ANSWER: stones in renal pelvis
,Right lower abdominal tenderness with a +Blumberg sign. What should be suspected? -
CORRECT ANSWER: Blumberg sign: Rebound tenderness in the RLQ, caused by
acute peritonitis.
*Appendicitis
What labs do we run to diagnose a kidney stone? - CORRECT ANSWER: UA dipstick,
urine microscopy and urine C&S
Serum blood urea nitrogen (BUN) and creatinine (Cr) to assess renal function.
What radiology methods are preferred for outpatient treatment and why - CORRECT
ANSWER: inexpensive, easily accessible. in combo its more practical
-KUB xray
-Renal Ultrasound
What stones can be seen on a KUB?
What stone can you not see on a KUB - CORRECT ANSWER: CAN see: Calcium
oxalate - most common type of stone
CANNOT see: uric acid stones (radio translucent)
What is a Renal Ultrasound used for when testing for kidney stones? - CORRECT
ANSWER: good for assessing for hydronephrosis (excess fluid in the kidney d/t back up
of urine that can be caused by an obstruction). Bad for identifying a stone.
What is the GOLD STANDARD for diagnosing a kidney stone? - CORRECT ANSWER:
Non-contrast CT scan.
Goal of renal calculi treatment - CORRECT ANSWER: focused on symptomatic relief
pain medications -NSAID or narcs
antiemetics -n/v
facilitate stone passage-Thiazide diuretics, alpha-blockers or calcium channel blockers
to help facilitate the passage of a stone. Terazosin -alpha blockers used for BPH.
, <5 mm renal calculi can - CORRECT ANSWER: be passed through the urine. may only
require NSAIDs for management.
>5 mm renal calculi requires what? - CORRECT ANSWER: urology consult.
this may cause an obstruction or kidney failure.
this type of stone may need surgical intervention to be removed.
when is a Urology Referral indicated? - CORRECT ANSWER: stone > 5mm
recurrent stones
When is a hospital admission appropriates for a patient with nephrolithiasis? -
CORRECT ANSWER: Hospital admission is indicated when:
-Inability to control pain
-Impaired renal function with an obstructing stone
-Infection (pyelonephritis or sepsis)
-Intractable n/v
What does a 24 hour urine collection analyze? - CORRECT ANSWER: -total volume
-urine pH
-calcium oxalate
-uric acid
-citrate
-sodium
-potassium
-creatinine
Factor Regarding hospital DC for nephrolithiasis - CORRECT ANSWER: -Pain is
reasonably controlled
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