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Nephroliathiasis

Nephroliathiasis. Ludwig Francillon 2/24/2014. Goals and Objectives. Define Nephrolithiasis Review the risk factors and etiology of renal stones Review the signs and symptoms and the evaluation of Renal Stones. Discuss the management renal stones.

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Nephroliathiasis

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  1. Nephroliathiasis Ludwig Francillon 2/24/2014

  2. Goals and Objectives • Define Nephrolithiasis • Review the risk factors and etiology of renal stones • Review the signs and symptoms and the evaluation of Renal Stones. • Discuss the management renal stones

  3. 31 y/o African American male presents with 3 day history of “back pain” that radiates to his groin. Patient denies any hematuria. Physical exam is positive for CVA tenderness. Patient is rolling around bed in obvious pain.  Patient was last seen 9 months ago with similar complaints and gross hematuria.What is next best step in management of this patient? • CT Scan • IV Morphine • IV Fluids • Renal Ultrasound • Xray (KUB) • Urinalysis Answer Now :22

  4. Risk Factors • Low fluid intake • History of prior stones or Family history • Conditions known to precipitate stone formation • Medications • Loop diuretics, acetazolamide, antacids, etc. • Male gender (3x more likely to have stones) • UTIs

  5. Types of stones • Calcium stones (Most Common) • Calcium oxylate or calcium phosphate • Uric Acid Stones • Struvite Stones (Staghorn Stones) • Cystine Stones

  6. Clinical Features • Renal Colic • Nausea and Vomiting • Hematuria • Dysuria and urgency • UTI

  7. Evaluation • Labs • UA, Urine Culture, BMP • Imaging • Xray KUB (Initial imaging test) • Helical CT without contrast (Most sensitive test) • IVP • Renal Ultrasound (Pts who should avoid radiation)

  8. Management • Analgesia • IV Morphine or ParenteralNSAIDs (Ketorolac) • Fluid Hydration • Imaging • Antibiotics (if UTI is present) • Outpatient vs Inpatient • Surgery • Extracoporeal shock wave lithotripsy (>5mm – 2cm) • PercutaneousNephrolithotomy (>2cm)

  9. Prevention • Dietary changes • Medication • Thiazide diuretics (Calcium stones) • Allopurinol (Uric acid stones)

  10. You can wake up now!

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