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KIDNEY STONES. Epidemiology. Affects 5-10% of Americans in their lifetime Chance of recurrence is about 50% Men are more often affected than women Average age of onset is between 20 and 30 years. Types and their causes. Calcium oxalate and phosphate:

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Presentation Transcript
  • Affects 5-10% of Americans in their lifetime
  • Chance of recurrence is about 50%
  • Men are more often affected than women
  • Average age of onset is between 20 and 30 years.
types and their causes
Types and their causes
  • Calcium oxalate and phosphate:

- Account for about 70% of stones.

- Causes include hypercalciuria,

hyperuricosuria, hyperoxaluria, etc

Magnesium Ammonium Phosphate:

- 15-20% of stones

- caused by urea-splitting bacteria Proteus and some


- Form the Staghorn calculi

Uric acid:

- 5-10% of stones

- Predisposed with gout, leukemias, or ???


- Only 1-2% of stones

- Caused by genetic defects in renal

reabsorption of amino acids.

clinical presentation
Clinical Presentation
  • Acute flank pain
  • Renal colic if passed into ureter or if obstruction
  • Urinary urgency or frequency
  • Hematuria
  • Nausea and vomiting
  • Fever and chills
  • Silent if large because remain in renal pelvis
  • History
  • Physical
  • Urinalysis to look for blood and bacteria, etc


  • CT Scan:

Noncontrast CT scans are now the modality of choice

Advantages include…..

1)elimination of contrast

2)no need for bowel prep

3) can see noncalcified stones

4) less expensive than IVP

5) does not require experienced radiologic technician.

diagnosis cont
Diagnosis cont.
  • Intravenous Pyelography:

Classic diagnostic test of choice

Advantages include…..

1) Can document nephrolithiasis and upper-tract anatomy

2) Oblique views can diff between gallstones and renal stones on the right.

Disadvantages include…..

1) Bowel prep

2) Reactions to contrast

3) Can take a really long time

diagnosis cont11
Diagnosis cont.
  • Abdominal plain film

Will reveal calculus in up to 80% of cases

Disadvantages include……

Stones must generally be at least 2mm in diameter

Stones must contain calcium to be visible

diagnosis cont13
Diagnosis cont.
  • Ultrasound

Advantages include….

Useful if patient is pregnant or has contraindication to IVP

When used with KUB can be as effective as IVP

  • Analgesia and hydration are most effective treatments
  • Shockwave lithotripsy for stones <2cm
  • Uteroscopy
  • Percutaneous nephrostomy and nephrouterostomy catheters to darin obstruction- especially important in urosepsis