Renal Stone Disease

2013
MINI-LECTURE
 Objectives

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
 Case

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
 Etiology

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
 Risk Factors

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
 Signs/Symptoms

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)

 Differential

Differential for flank pain with hematuria

UTI

Renal Cell Carcinoma

Ectopic pregnancy

Dissecting AAA with renal artery involvement

 Types of Stones

In order of prevalence
Calcium Oxalate

Calcium Phosphate

Struvite

Urice Acid

Cystine
 Workup

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

 Workup

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.
 Treatment

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
 Summary

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