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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

Renal stones

Dr.Bandar Al Hubaishy

Urology Department

KAUH

clinical picture
Clinical picture
  • Renal stones:

Small stones:

Pain

Infection

Hematouria

slide3
Large renal stones:

They are asymptomatic e.g. staghorn stones

Which are associated by UTI

slide4
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
Physical examination
  • Costovertebral angel tenderness
  • No peritoneal signs
work up
Work up

Laboratory

slide7
Urine analysis

for evidence of hematouria and infection

  • CBC

for evidence of systemic infection

slide8
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
slide13
KUB

Renal ultrasound

Spiral C.T abdomen without contrast

IVP

slide14
KUB

To detect radiopaque stones

To follow up the radiopaque stone

ultrasound
Ultrasound

For radiolucent stones and for pregnant stones

To assess the presence of hydronephrosis

It can not assess the presence of ureteric stones

slide16
IVP
  • It assess both function and anatomy of the renal system
  • Delayed nephrogram is the only hallmark for urinary tract obstruction
slide17
Contraindications of IVP:

Pregnancy

Pediatric

Allergy

Mettformin

Renal impairment

slide18
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.
slide20
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.
slide21
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.
slide23
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:

Hydration

Ebimag

Follow up in the clinic with KUB every 2 weeks

slide25
Renal stones size 0.7mm-2cm:

ESWL

Hydration

Analgesic

KUB follow up in the clinic

slide26
Renal stones bigger than 2 cm

Percutaneous nephrostolithotomy (PCNL)

ureteric stones
Ureteric Stones

Non obstructing stone:

  • Hydration
  • Ebimag
  • Analgesic
slide28
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
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