Renal calculi
Definition stones that form within the Signs + symptoms
renal tract Loin pain
o Severe
Classification
o Intermittent ‘colic’ pain
Types Features o Nausea + vomiting
Hypercalciuria (major risk o Haematuria
factor) o Secondary infection may
Hyperoxaluria (increases risk) cause fever
Hypocitraturia (increases risk o Dysuria
Calcium
forms complexes w/ Ix
oxalate
calcium making it more 24hr urine analysis:
(85%)
soluble) Assess levels of calcium, uric acid,
Hyperuricosuria = uric acid oxalate + citrate
stones + calcium oxalate USS kidneys (1st line)
Stones are radio-opaque (< CT kidney, ureter, bladder (KUB)
calcium phosphate) (2nd line)
May precipitate when urinary Chemical analysis of stones
Uric
pH low may be caused by
acid (5-
diseases w/ extensive tissue
10%)
breakdown e.g. malignancy
Stones are radiolucent
Mg2+, NH3 + PO43- occurs as a
result of urease-producing Management
bacteria (associated w/ Initial mx of renal colic
Struvite Diclofenac (IM/oral)
chronic infections)
(2-20%) Alpha-blockers to aid ureteric stone
Under the alkaline
environment crystals form passage
Stones are slightly radio- Imaging = USS non-contrast CT
opaque Stones < 5mm will pass spontaneously
Stones are radio-dense (w/i 4 weeks)
Cystein Mx of stones
Contain sulphur, reduced
e Stones + infection = EMERGENCY
absorption of cysteine from
intestine + renal tubule decompress e.g. nephrostomy tube
Renal tubular acidosis placement, insertion of catheter,
Calcium ureteric stent placement
High urinary pH increases
phospha Disease
supersaturation of urine w/
te Stone burden < 2cm aggregate
calcium + phosphate
lithotripsy
Aetiology Stone burden < 2cm pregnant female
Idiopathic, hypercalcaemia, ureteroscopy
Complex renal calculi + staghorn calculi
uricaemia, oxaluria, percutaneous nephrolithotomy
recurrent UTI Ureteric calculi < 5mm Mx
Drugs e.g. Loop diuretic expectantly
Hereditary conditions Prevention
Calcium = High fluids, low salt, low
increase risk e.g. PKD animal protein, thiazide diureticss
Uric acid = allopurinol/oral HCO3-
Oxalate = Cholestyramine + pyridoxine
reduce urinary oxalate secretion
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