EVALUATION AND MEDICAL

MANAGEMENT OF URINARY LITHIASIS

MAJ. HAFIZ
 CONTENT

• 1. IMAGING FOR URINARY LITHIASIS

• 2. METABOLIC EVALUATION
• 3. STONE ANALYSIS
• 4. GENERAL RECOMMENDATIONS FOR STONE
FORMERS
• 5. SPECIFIC RECOMMENDATION
IMAGING FOR URINARY LITHIASIS

• Computed Tomography
• Non-contrast computed tomography (CT) imaging is the gold
standard in terms of diagnostic accuracy for stones, with a
reported sensitivity of 98% and a specificity of 97%
• An additional advantage of CT scanning for stones is the
ability to obtain detailed anatomic information about the
kidney itself including the presence or absence of
hydronephrosis, perinephric stranding, and parenchymal
abnormalities.
IMAGING FOR URINARY LITHIASIS

• Computed Tomography (Cont.)

• CT also has the potential to provide insight into stone
composition.
• The classic example of this is for uric acid stones, which are
radiolucent on conventional radiography but well visualized
on CT.
IMAGING FOR URINARY LITHIASIS

• Radiography (KUB and IVU)

• Used alone, without contrast, KUB has an estimated
sensitivity of 57% and a specificity of 76%
• IVUs can improve the ability to detect stones through better
delineation of the pelvi-calyceal and ureteral anatomy, but
even so, they have an estimated sensitivity of only 70%
despite a better specificity (95%)
IMAGING FOR URINARY LITHIASIS

• Ultrasound
• The biggest disadvantage of RUS for stones though remains a
poor sensitivity (61%) despite adequate specificity (97%)
IMAGING FOR URINARY LITHIASIS
 METABOLIC EVALUATION

• Any evaluation should be able to identify associated metabolic

disorders responsible for recurrent stone disease.
• These metabolic problems include distal renal tubular acidosis
(RTA), primary hyperparathyroidism, enteric hyperoxaluria,
cystinuria, and gouty diathesis.
• All children should undergo a full metabolic evaluation
because they have been found to have a significant risk for
underlying metabolic disturbances
METABOLIC EVALUATION
METABOLIC EVALUATION
METABOLIC EVALUATION
 METABOLIC EVALUATION

• 24-Hour Urine Collection

• The urinary constituents most commonly assayed include
calcium, oxalate, citrate, total volume, sodium, magnesium,
potassium, pH, uric acid, and sulfate
• Use specific laboratory supplied container with preservatives,
which should be kept refrigerated on the day.
• Discard the first morning urine, catch from the second urine to
next day morning first urine sample.
METABOLIC EVALUATION
 STONE ANALYSIS

• The AUA guidelines on medical management of kidney stones

recommend obtaining a stone analysis at least once when one
is available to help classify patients and guide preventive
measures.
• Because most stones are a mixture of more than one
component, the relative ratios or predominance of any
particular molecule may have predictive value
STONE ANALYSIS
 GENERAL RECOMMENDATIONS FOR
STONE FORMERS
• Fluid Recommendations
• Mainstay of conservative management for kidney stone
prevention is increased fluid intake to achieve a urine output
of at least 2.5 L/day
• Epidemiologic data has demonstrated that consumption of
sugar-sweetened soda and punch is associated with a higher
risk for stone formation, and coffee, tea, beer, and wine are
associated with a lower risk for stone formation
 GENERAL RECOMMENDATIONS FOR
STONE FORMERS
• Animal Protein
• Nondairy animal protein (meat, fish, poultry, eggs) intake can
affect several urinary parameters that may increase kidney
stone risk including calcium, uric acid, oxalate, and citrate
• Epidemiologic studies have suggested that the incidence of
nephrolithiasis is higher in populations in which there is
increased animal protein intake
• Diets high in potassium and lower in animal protein may be
effective in preventing kidney stone formation.
 GENERAL RECOMMENDATIONS FOR
STONE FORMERS
• Animal Protein
• Dietary Approaches to Stop Hypertension (DASH) diet has
been evaluated for its effect on kidney stone formation.
• The DASH diet is rich in fruits and vegetables, moderate in
low-fat dairy products, and low in animal protein. In a
prospective population-based study, higher DASH scores were
associated with a lower risk for kidney stone formation
SPECIFIC RECOMMENDATION
 SPECIFIC RECOMMENDATION

• Calcium based stone

 SPECIFIC RECOMMENDATION

• Uric Acid Stones

 SPECIFIC RECOMMENDATION

• Cystine Stone
 SPECIFIC RECOMMENDATION

• Infection Calculi
 CONCLUSION

•Qustion?
•Thank You