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What is nephrolithiasis?
renal calculi (kidney stones)
How does Renal calculi form?
formed d/t elevated levels of minerals in the body
What minerals in excess can cause renal calculi?
calcium oxalate (most common),
phosphate
uric acid
struvite
cystine
Urolithiasis
stone in the bladder
,Ureterolithiasis
condition of stones in the ureter
Risk Factor & complications of renal calculi
-Male, 20-50yo, previous stones, obesity, HTN, diabetes, low fluid intake.
-complications of stones: obstructions, pyelonephritis (kidney infection), CKD
Classic Kidney stone presentation
acute onset of severe, colicky flank pain that wax and wane in intensity.
Severe pain is associated with the movement of the stone and can cause n/v.
pt may seem anxious and unable to sit still
history and physical for nephrolithiasis (kidney stones)
Irritative Bladder symptoms -dysuria (painful or difficulty urinating), urgency, & frequency
Vague flank pain or acute colicky pain with increasing intensity
Radiation of pain into the groin
Costovertebral angle (CVA) tenderness
Hematuria
Diaphoretic, tachycardic, appear extremely uncomfortable
CVA tenderness tell your the stone is located where?
caused by passing of the stone through the ureter with obstruction & spasm
,Where is the stone located if the patient has pain in the groin region?
pain that radiates downward into the groin indicates the stone has passed into the lower third
of the ureter
Vague flank pain or acute colicky pain with increasing intensity means the stone is located
where?
stones in renal pelvis
Differential Diagnosis for abdominal pain and/or flank pain:
Nephrolithiasis (kidney stones)
Pyelonephritis (kidney infection)
Ectopic pregnancy
Ovarian or testicular torsion
Appendicitis
Bowel obstruction
Diverticulitis
Rupture of aortic aneurysm
Right lower abdominal tenderness with a +Blumberg sign. What should be suspected?
Blumberg sign: Rebound tenderness in the RLQ, caused by acute peritonitis.
*Appendicitis
, What labs do we run to diagnose a kidney stone?
UA dipstick, urine microscopy and urine C&S
Serum blood urea nitrogen (BUN) and creatinine (Cr) to assess renal function.
What radiology methods are preferred for outpatient treatment and why
inexpensive, easily accessible. in combo its more practical
-KUB xray
-Renal Ultrasound
What stones can be seen on a KUB?
What stone can you not see on a KUB
CAN see: Calcium oxalate - most common type of stone
CANNOT see: uric acid stones (radio translucent)
What is a Renal Ultrasound used for when testing for kidney stones?
good for assessing for hydronephrosis (excess fluid in the kidney d/t back up of urine that can be
caused by an obstruction). Bad for identifying a stone.