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Stones & Cysts


90% of stones are: radiopaque (visible): Ca & struvite). Uric acid & cystine stones are radiolucent.
Calcium oxalate or Ca phosphate stones 75%; occasionally with chronic hypercalcemia (hyperparathyroidism)
Magnesium – ammonium – phosphate (struvite) stones: prevalence 10-15%
Uric Acid / cystine stones: prevalence (%) Uric Acid 5-8% of all kidney stones. Cystine 1-3%
Stones: DDx AAA; Appendicitis; Tuboovarian Abscess (TOA); Ectopic Pregnancy
Urolithiasis: dx imaging noncontrast CT (high sensitivity); US (hydronephrosis; good for PG); KUB (less specific)
Urolithiasis admission criteria Infection / Sepsis; Complete Obstruction; Deteriorating renal fn; Intractable N/V; Solitary kidney; Very large or proximal stones
Renal stones lodge at: UPJ (kidney stones), ureterovesicular junction/UVJ (bladder stones), or ureter at level of iliac vessels
Urolithiasis RFs Prior stones, FH, low Ca/fluid intake, high oxalate/pro/Na intake, gastric bypass (RYGB); gout, DM, obesity, chronic UTIs, chronic diarrhea
Struvite stones form in pts with: recurrent UTI (urease forming bacteria: proteus / klebsiella). Staghorn: often struvite
Urolithiasis clinical features colicky flank pain +/- hematuria +/- fever/chills, N/V
Symptoms of renal stone in upper ureter: radiate to anterior abdomen
Symptoms of renal stone in lower ureter: radiate to ipsilateral groin, testes/ labia
Symptoms of renal stone in UVJ: urgency, frequency, pelvic pain
ADPKD comorbididities Berry aneurysms of the circle of Willis; cerebellar hemangioblastomas; hepatic cyst; hypertension (<50% of pts); valvular heart dz; divertic; renal failure
Meds contributing to stone formation Antacids, carbonic anhydrase inhibitors (raise urine pH). Loop diuretics (increase urine Ca concentrations), thiazides (uric acid stones). Large doses vitamin C (-> hyperoxaluria)
Dietary factors on stone formation Animal protein metabolism -> metabolic acidosis -> more Ca filtered/hypercaliuria. Meat (purine) -> uric acid. Green leafy (oxalate) -> Ca oxalate stones
Secondary causes of stones HyperPTH, hyperthyroid, Cushing, granulomatous (sarcoid/TB/dissem candida), immobility, vit D intox, bone dz
Kidney stone dx Stone analysis to ID. Noncontrast CT is TOC. US can show obstruction & hydro. 24hr urine, Urine Ca:Cr ratio. Check PTH in chronic pt if Ca elevated.
Kidney stone mgmt IV fluids, analgesia. Most <5mm stones pass spontaneously. 5-10mm may need removal. Diet to lower Ca/ oxalate
UA findings in stones pH <5.0 = uric acid & cystine. pH > 7.2 = struvite
Stones removed by: lithotripsy (ESWL) or ureteroscopy w/extraction. Stones >10mm may require admission for lithotripsy or percutaneous nephrolithotomy
Medullary sponge kidney characteristics Benign. Hereditary AD: MCKD1 or MCKD2 mutation on chromosomes 1 & 16. Dx in 4th-5th decade.
ADPKD genetics Chromosome 16 short arm defect (90%). Chromosome 4 (10-15%), slower w/longer life expectancy
Epithelium-lined cavities filled with fluid or semisolid that develop from renal tubular elements = cysts (70% of all renal masses)
Dx study for medullary sponge kidney Intravenous pyelogram (IVP) - will show striations in papillary portions (=contrast accumulation in dilated collecting ducts)
Large echogenic kidneys on US = ADPKD
Created by: Adam Barnard Adam Barnard