Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH

Renal stones

Dr.Bandar Al Hubaishy

Urology Department

KAUH

Clinical picture

Renal stones:

Small stones:

Pain

Infection

Hematouria

Large renal stones:

They are asymptomatic e.g. staghorn stones

Which are associated by UTI

Ureteric stones:Renal colic: it is a severe colicky pain in the flank that

can radiate to the groin and scrotum in male

Nausea and vomiting

Hematouria

Irritative symptoms as the stones in the distal part of the ureter

Physical examination

Costovertebral angel tenderness

No peritoneal signs

Work up

Laboratory

Urine analysis

for evidence of hematouria and infection

CBC

for evidence of systemic infection

Serum electrolytes Serum calcium PTH Phosphate Uric acid

Metabolic screen

24 hours urinary collection offor levels of pH, calcium, oxalate, uric acid, sodium, phosphorus, citrate, magnesium, creatinine, and total volume

The goal of metabolic screen

To prevent future stone formation due to metabolic abrnomalities

Indications for metabolic screen

Residual calculi after surgical treatment Initial presentation with multiple calculi Initial presentation before age 30 years Renal failure Solitary kidney (including renal transplant) Family history of calculi More than one stone in the past year Bilateral calculi

Imaging studies

KUB

Renal ultrasound

Spiral C.T abdomen without contrast

IVP

KUB

To detect radiopaque stones

To follow up the radiopaque stone

Ultrasound

For radiolucent stones and for pregnant stones

To assess the presence of hydronephrosis

It can not assess the presence of ureteric stones

IVP

It assess both function and anatomy of the renal system

Delayed nephrogram is the only hallmark for urinary tract obstruction

Contraindications of IVP:

Pregnancy

Pediatric

Allergy

Mettformin

Renal impairment

It is no longer used as the standard for the initial evaluation of a patient with a kidney stone :

Up to 6 hours may be required to complete the study in the presence of severe obstruction.

For optimal results, IVU requires a bowel preparation.

It involves intravenous injection of potentially allergic and mildly nephrotoxic contrast material

Spiral C.T abdomin and Pelvis without contrast

It is the best initial radiographic examination for acute renal colic.

Advantages of a CT scanning include the following: It can reveal other pathology (eg,

abdominal aneurysms, appendicitis, cholecystis). It can be performed quickly. It avoids the use of intravenous contrast materials.

Disadvantages of CT scanning include the following:

It cannot be used to assess individual renal function.

It can fail to reveal some unusual radiolucent stones, such as those caused by indinavir, which are invisible on the CT scan. Because of this possibility, IVUs with contrast should be used for patients taking indinavir.

It is relatively expensive.

It exposes the patient to a relatively high radiation dose. Precise identification of small distal stones is

occasionally difficult. It is not suitable for tracking the progress of the stone

over time, supporting the recommendation for KUB radiography along with the CT scan.

MANAGEMENT

It depends on the site , size and the general condition of the patient

The management involve medical and surgical management

Renal Stones

Small renal stones less than 0.6 mm:

Hydration

Ebimag

Follow up in the clinic with KUB every 2 weeks

Renal stones size 0.7mm-2cm:

ESWL

Hydration

Analgesic

KUB follow up in the clinic

Renal stones bigger than 2 cm

Percutaneous nephrostolithotomy (PCNL)

Ureteric Stones

Non obstructing stone:

Hydration Ebimag Analgesic

Obstructing ureteric stone If the patient is stable, ureteroscopy and

lithotripsy

If the patient is not stable,do double j stent insertion or nephrostomy tube to decompress the obstruction