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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



  • 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


  • Urine analysis

    for evidence of hematouria and infection

  • CBC

    for evidence of systemic infection



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



KUB

Renal ultrasound

Spiral C.T abdomen without contrast

IVP


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


IVP

  • It assess both function and anatomy of the renal system

  • Delayed nephrogram is the only hallmark for urinary tract obstruction



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 evaluation of a patient with a kidney stone :

  • 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: evaluation of a patient with a kidney stone :

  • 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. evaluation of a patient with a kidney stone :

  • 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 evaluation of a patient with a kidney stone :



Renal stones1
Renal Stones the patient

  • Small renal stones less than 0.6 mm:

    Hydration

    Ebimag

    Follow up in the clinic with KUB every 2 weeks




Ureteric stones
Ureteric Stones the patient

Non obstructing stone:

  • Hydration

  • Ebimag

  • Analgesic


Obstructing ureteric stone the patient

  • 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


THANK YOU the patient


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