1 Evaluation and treatment of kidney stones for the primary care provider Jason Bylund, MD University of Kentucky Division of Urology Objectives • Review basic principles of evaluation of the patient with suspected kidney stone event • Describe urgent or emergent clinical scenarios associated with stones • Discuss medical and surgical treatment options for patients with stones 2 Disclosures • None 3 Background • Urinary tract stones, urolithiasis, will affect approximately 5-10% of American adults in their lifetime 1 • Renal colic accounts for over a million ER visits annually 2 • Rates higher in “Stone Belt” Presentation • Acute stone episode vs incidental finding • Common presenting symptoms: • Flank pain radiating to groin (renal colic) • Nausea/vomiting • Hematuria • Voiding symptoms (frequency, urgency, dysuria) • Writhing or pacing
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1
Evaluation and treatment of kidney stones for the primary care provider
Jason Bylund, MDUniversity of Kentucky
Division of Urology
Objectives
• Review basic principles of evaluation of the patient with suspected kidney stone event
• Describe urgent or emergent clinical scenarios associated with stones
• Discuss medical and surgical treatment options for patients with stones
2
Disclosures
• None
3
Background
• Urinary tract stones, urolithiasis, will affect approximately 5-10% of American adults in their lifetime1
• Renal colic accounts for over a million ER visits annually2
• Rates higher in “Stone Belt”
Presentation• Acute stone episode vs incidental
finding
• Common presenting symptoms:• Flank pain radiating to groin (renal colic)
• Nausea/vomiting
• Hematuria
• Voiding symptoms (frequency, urgency, dysuria)
• Writhing or pacing
2
Obstructing ureteral stone Diagnosis• History
• History of stones, risk factors, co-morbidities, medications
• Physical exam• Abdomen, CVA (no peritoneal signs)
• GU and rectal exam to rule out other causes
• Labs• CBC, BMP, UA
Imaging
• CT (low dose) stone protocol – gold standard
• KUB – radiopacity, monitoring
• Renal U/S – select cases
• IVP – useful for functional evaluation and anatomical mapping
11 12
3
Red flags• Fever
• Evidence of UTI
• Solitary kidney
• Acute kidney injury
• Uncontrolled pain, nausea, vomiting
• Perinephric stranding
• Hydronephrosis
Treatment?• Pain control
• NSAIDs, narcotics, abx
• Emergent renal drainage?• Stent vs percutaneous nephrostomy tube
• Medical expulsive therapy• Alpha-blockers, IVFs?