Renal Stone Disease

2013
MINI-LECTURE
 Objectives

 Identify common risk factors for renal stone disease

 Identify common signs and symptoms for renal
stone disease
 Know the common types of renal stones
 Familiarize with basics of renal stone management,
including knowing when to consult urology
 Case

 49 year old woman with history of hypertension,

diabetes presents with four day history of right sided
flank pain and “pink urine.” What is the most
appropriate imaging to diagnose this patient with
renal stone disease?
 A: KUB
 B: Ultrasound
 C: Contrast-enhanced CT
 D: Non-Contrast CT
 Etiology

 Supersaturation of urine with solutes

 Solubility is affected by urine pH, volume and total
excretion
 Those factors can often be modified with
medications and diet
 Risk Factors

 Male sex
 Obesity
 Family History
 H/o stone disease (1/2 will have recurrence)
 Dietary factors
 Lower fluid intake, higher animal protein, higher Vitamin C

 Medical factors
 Signs/Symptoms

 Typical symptoms
 Sudden onset

 Unilateral colicky flank pain radiating to groin (localization of

pain evolves as stone migrates)
 Often with nausea/vomiting

 Hematuria (microscopic or gross)

 Differential

 Differential for flank pain with hematuria

 UTI

 Renal Cell Carcinoma

 Ectopic pregnancy

 Dissecting AAA with renal artery involvement

 Types of Stones

 In order of prevalence
 Calcium Oxalate

 Calcium Phosphate

 Struvite

 Urice Acid

 Cystine
 Workup

 Urinalysis: may show

 Hematuria (90% sensitive)

 Signs of infection

 Crystals

 Elevated pH (urea-splitting bugs?) or low pH (RTA?)

 Metabolic workup: Consider only if recurrent

 Workup

 Imaging
 Non-Contrast helical CT with Stone protocol is the gold std
(can detect stones not visible by KUB/IVP and has significantly
better sensitivity/specificity)
 Ultrasound: For patients needing avoidance of radiation
(pregnant, childbearing age)
 IVP: No longer favored due to lower sensitivity, HIGHER
radiation exposure
 KUB: Will miss radiolucent uric acid stones, small stones,
stones with overlying bony structures.
 Treatment

 Urologic Intervention?
 X<5mm : most pass spontaneously. Possible observation and
pain control
 X>5mm : less than 20% chance of passage and may need
urologic intervention
 So when to consult urology?
 If > 5mm
 For ANY size with ….
 Urosepsis, AKI, anuria, unyielding N/V/Pain -> Inpatient consult
 Failed conservative management and stone did not pass
spontaneously -> Inpatient or Outpatient consult depending on
severity
 Summary

 Identified common risk factors for renal stone

disease
 Identified common signs and symptoms for renal
stone disease
 Know the common types of renal stones
 Familiarized with basics of renal stone management,
including knowing when to consult urology