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KIDNEY STONES (PowerPoint)

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					KIDNEY STONES
          Epidemiology
Affects 5-10% of Americans in their
lifetime
Chance of recurrence is about 50%
Men are more often affected than women
Average age of onset is between 20 and
30 years.
     Types and their causes
Calcium oxalate and phosphate:
  - Account for about 70% of stones.
  - Causes include hypercalciuria,
  hyperuricosuria, hyperoxaluria, etc
Magnesium Ammonium Phosphate:
  - 15-20% of stones
  - caused by urea-splitting bacteria Proteus and some
    Staph
  - Form the Staghorn calculi
Uric acid:
 - 5-10% of stones
 - Predisposed with gout, leukemias, or ???


Cystine:
 - Only 1-2% of stones
 - Caused by genetic defects in renal
   reabsorption of amino acids.
       Clinical Presentation
Acute flank pain
Renal colic if passed into ureter or if obstruction
Urinary urgency or frequency
Hematuria
Nausea and vomiting
Fever and chills
Silent if large because remain in renal pelvis
              Diagnosis
History
Physical
Urinalysis to look for blood and bacteria,
etc
                         Diagnosis
IMAGING STUDIES
  CT Scan:
Noncontrast CT scans are now the modality of
  choice
Advantages include…..
1)elimination of contrast
2)no need for bowel prep
3) can see noncalcified stones
4) less expensive than IVP
5) does not require experienced radiologic technician.
CT Images of Stones
              Diagnosis cont.
    Intravenous Pyelography:
Classic diagnostic test of choice
Advantages include…..
1) Can document nephrolithiasis and upper-tract anatomy
2) Oblique views can diff between gallstones and renal
    stones on the right.
Disadvantages include…..
1) Bowel prep
2) Reactions to contrast
3) Can take a really long time
IVP
             Diagnosis cont.
  Abdominal plain film
Will reveal calculus in up to 80% of cases
Disadvantages include……
 Stones must generally be at least 2mm in
  diameter
 Stones must contain calcium to be visible
KUB of stones
           Diagnosis cont.
Ultrasound
 Advantages include….
Useful if patient is pregnant or has
 contraindication to IVP
When used with KUB can be as effective as IVP
Ultrasound of stone
            Treatments
Analgesia and hydration are most effective
treatments
Shockwave lithotripsy for stones <2cm
Uteroscopy
Percutaneous nephrostomy and
nephrouterostomy catheters to darin
obstruction- especially important in
urosepsis
PNT placement
       Percutaneous
         nephrostomy tube is
         placed by an
         interventional
         radiologist
THE END

				
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posted:8/20/2011
language:English
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