By- Dr. Armaan Singh

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

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

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

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

Typical symptomsSudden onsetUnilateral colicky flank pain radiating to

groin (localization of pain evolves as stone migrates)

Often with nausea/vomitingHematuria (microscopic or gross)

Differential for flank pain with hematuriaUTIRenal Cell CarcinomaEctopic pregnancy Dissecting AAA with renal artery

involvement

In order of prevalenceCalcium OxalateCalcium PhosphateStruviteUrice AcidCystine

Urinalysis: may showHematuria (90% sensitive)Signs of infectionCrystalsElevated pH (urea-splitting bugs?) or low pH

(RTA?) Metabolic workup: Consider only if

recurrent

ImagingNon-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.

Urologic Intervention? X<5mm : most pass spontaneously.

Possible observation and pain control X>5mm : less than 20% chance of passage

and may need urologic interventionSo 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

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