Renalstones

1. By- Dr. Armaan Singh

2.  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

3.  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

4.  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

5.  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

6.  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)

7.  Differential for flank pain with hematuria
 UTI
 Renal Cell Carcinoma
 Ectopic pregnancy
 Dissecting AAA with renal artery involvement

8.  In order of prevalence
 Calcium Oxalate
 Calcium Phosphate
 Struvite
 Urice Acid
 Cystine

9.  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

10.  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.

11. 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

13.  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