![]() ![]() Tamsulosin (an alpha-blocker) can be used to help aid the spontaneous passage of stones. It can take several weeks for the stone to pass. It may also be suitable for patients with stones 5-10mm, depending on individual factors. Watchful waiting is usually used in stones less than 5mm, as there is a 50-80% chance they will pass without any interventions. Opiates are not very helpful for pain management and are not routinely used.Īntiemetics are used for nausea and vomiting (e.g., metoclopramide, prochlorperazine or cyclizine).Īntibiotics are required if infection is present. IV paracetamol is an alternative, where NSAIDs are not suitable. NSAIDs are the most effective type of analgesia, for example, intramuscular diclofenac. The three causes to remember are calcium supplementation, hyperparathyroidism and cancer (e.g., myeloma, breast or lung cancer). You can remember the presentation of hypercalcaemia with the mnemonic “renal stones, painful bones, abdominal groans and psychiatric moans”. TOM TIP: Remember hypercalcaemia as a cause of kidney stones. Stones can be analysed to determine the type, which can help establish the cause and reduce the risk of recurrence. It is less effective at identifying kidney stones but is helpful in pregnant women and children. A negative result does not exclude kidney stones. Ultrasound of the kidneys, ureters and bladder ( ultrasound KUB) is a less preferred alternative to CT scan. The NICE guidelines (2019) recommend a CT within 24 hours of the presentation. Non-contrast computer tomography ( CT) of the kidneys, ureters and bladder ( CT KUB) is the initial investigation of choice for diagnosing kidney stones. Checking the serum calcium helps identify hypercalcaemia that may have caused the kidney stone.Īn abdominal x-ray can show calcium-based stones, but uric acid stones will not show up (they are radiolucent). Urine dipsticks are also helpful to exclude infection.īlood tests help establish signs of infection and also kidney function. A normal urine dipstick does not exclude stones. Urine dipstick usually shows haematuria in cases of kidney stones. Symptoms of sepsis, if infection is present.Patients often move restlessly due to the pain. Colicky (fluctuating in severity) as the stone moves and settles.Unilateral loin to groin pain that can be excruciating (“worse than childbirth”).Renal colic is the presenting complaint in symptomatic kidney stones. Renal stones may be asymptomatic and never cause an issue. In recurrent upper urinary tract infections, the bacteria can hydrolyse the urea in urine to ammonia, creating the solid struvite. Most commonly, this occurs with stones made of struvite. The body sits in the renal pelvis with horns extending into the renal calyces. Cystine – associated with cystinuria, an autosomal recessive diseaseĪ staghorn calculus is where the stone forms in the shape of the renal pelvis, giving it a similar appearance to the antlers of a deer stag.Struvite – produced by bacteria, therefore, associated with infection.Uric acid – these are not visible on x-ray.Having a raised serum calcium ( hypercalcaemia) and a low urine output are key risk factors for calcium collecting into a stone. Infection with obstructive pyelonephritisĬalcium-based stones are the most common type of kidney stone (about 80%).Obstruction leading to acute kidney injury.They might get stuck at any point along the ureters, but commonly at the vesico-ureteric junction. They may be asymptomatic until they irritate or get stuck in the ureters. ![]() They are hard stones that form in the renal pelvis, where the urine collects before travelling down the ureters. Renal stones as also referred to as renal calculi, urolithiasis and nephrolithiasis. ![]()
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