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Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH
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Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Mar 31, 2015

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Page 1: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Renal stones

Dr.Bandar Al Hubaishy

Urology Department

KAUH

Page 2: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Clinical picture

Renal stones:

Small stones:

Pain

Infection

Hematouria

Page 3: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Large renal stones:

They are asymptomatic e.g. staghorn stones

Which are associated by UTI

Page 4: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

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

Page 5: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Physical examination

Costovertebral angel tenderness

No peritoneal signs

Page 6: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Work up

Laboratory

Page 7: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Urine analysis

for evidence of hematouria and infection

CBC

for evidence of systemic infection

Page 8: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Serum electrolytes Serum calcium PTH Phosphate Uric acid

Page 9: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Metabolic screen

24 hours urinary collection offor levels of pH, calcium, oxalate, uric acid, sodium, phosphorus, citrate, magnesium, creatinine, and total volume

Page 10: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

The goal of metabolic screen

To prevent future stone formation due to metabolic abrnomalities

Page 11: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

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

Page 12: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Imaging studies

Page 13: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

KUB

Renal ultrasound

Spiral C.T abdomen without contrast

IVP

Page 14: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

KUB

To detect radiopaque stones

To follow up the radiopaque stone

Page 15: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Ultrasound

For radiolucent stones and for pregnant stones

To assess the presence of hydronephrosis

It can not assess the presence of ureteric stones

Page 16: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

IVP

It assess both function and anatomy of the renal system

Delayed nephrogram is the only hallmark for urinary tract obstruction

Page 17: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Contraindications of IVP:

Pregnancy

Pediatric

Allergy

Mettformin

Renal impairment

Page 18: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

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

Page 19: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

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.

Page 20: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

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.

Page 21: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

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.

Page 22: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

MANAGEMENT

Page 23: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

It depends on the site , size and the general condition of the patient

The management involve medical and surgical management

Page 24: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Renal Stones

Small renal stones less than 0.6 mm:

Hydration

Ebimag

Follow up in the clinic with KUB every 2 weeks

Page 25: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Renal stones size 0.7mm-2cm:

ESWL

Hydration

Analgesic

KUB follow up in the clinic

Page 26: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Renal stones bigger than 2 cm

Percutaneous nephrostolithotomy (PCNL)

Page 27: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

Ureteric Stones

Non obstructing stone:

Hydration Ebimag Analgesic

Page 28: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.

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

Page 29: Renal stones Dr.Bandar Al Hubaishy Urology Department KAUH.