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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:

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Renal stones

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Renal stones

Renal stones

Dr.Bandar Al Hubaishy

Urology Department


Clinical picture

Clinical picture

  • Renal stones:

    Small stones:




Renal stones

  • Large renal stones:

    They are asymptomatic e.g. staghorn stones

    Which are associated by UTI

Renal stones

  • 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


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

Physical examination

Physical examination

  • Costovertebral angel tenderness

  • No peritoneal signs

Work up

Work up


Renal stones

  • Urine analysis

    for evidence of hematouria and infection

  • CBC

    for evidence of systemic infection

Renal stones

  • Serum electrolytes

  • Serum calcium

  • PTH

  • Phosphate

  • Uric acid

Metabolic screen

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

The goal of metabolic screen

  • To prevent future stone formation due to metabolic abrnomalities

Indications for metabolic screen

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

Renal stones

Imaging studies

Renal stones


Renal ultrasound

Spiral C.T abdomen without contrast


Renal stones


To detect radiopaque stones

To follow up the radiopaque stone



For radiolucent stones and for pregnant stones

To assess the presence of hydronephrosis

It can not assess the presence of ureteric stones

Renal stones


  • It assess both function and anatomy of the renal system

  • Delayed nephrogram is the only hallmark for urinary tract obstruction

Renal stones

  • Contraindications of IVP:





    Renal impairment

Renal stones

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

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.

Renal stones

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.

Renal stones

  • 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.

Renal stones


Renal stones

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

  • The management involve medical and surgical management

Renal stones1

Renal Stones

  • Small renal stones less than 0.6 mm:



    Follow up in the clinic with KUB every 2 weeks

Renal stones

  • Renal stones size 0.7mm-2cm:




    KUB follow up in the clinic

Renal stones

  • Renal stones bigger than 2 cm

    Percutaneous nephrostolithotomy (PCNL)

Ureteric stones

Ureteric Stones

Non obstructing stone:

  • Hydration

  • Ebimag

  • Analgesic

Renal stones

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

Renal stones


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