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Renal Calculus

Dr Swapnil Pawar September 6, 2021 20


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    Renal Calculus
    Dr Swapnil Pawar

Renal Calculus

The blog is written by Dr Andrew Lam

Management of Renal Calculi

Reasons for admission:
– Inability to tolerate oral intake due to nausea and vomiting
– Uncontrollable pain
– Fever

For all renal calculi:
Regular analgesia, often requiring NSAID’s and opiates
Anti-emetics if nauseous and vomiting
Advised patient to strain when voiding to encourage the passing of the stone

If <5mm – appropriate for outpatient management 

If 5-10mm – appropriate for outpatient management. Tamsulosin can be commenced  to encourage spontaneous passage of stone

If >10mm – Unlikely to pass spontaneously, and hence, urological referral for surgical intervention is advised

If stones <10mm do not pass spontaneously within 4 weeks, then urological input is also advised. Potential options for surgical input include:
– Shock Wave Lithotripsy
– Ureteroscopy with lithotripsy
– Percutaneous nephrolithotomy
In rare cases – laparoscopic stone removal may be indicated

At any point in time, if the patient spikes fevers or becomes septic, then urgent urology referral is warranted for a stent or nephrostomy for decompression

Prevention of Renal Calculi

For all stones, recommended measures include:
– Increased fluid intake to decrease the concentration of urine and hence, risk of precipitation
– Weight loss
– Decreased sodium intake
– Increased fruit and vegetable intake

Additional measures can be considered depending on the composition of the stone:

Calcium oxalate/phosphate
– Maintaining adequate calcium in diet (hypocalcemia worsens risk)
– Reduce animal protein intake
– Limit sucrose and fructose intake

Uric Acid
– Alkalinisation of urine
– Uric acid-lowering therapy (i.e. xanthine oxidase inhibitor)

Cystine
– Alkalinisation of urine
– Thiol containing drugs (i.e. tiopronin, D-penicillamine)

Struvite
– Antimicrobial therapy
– Urease inhibitors

References:

Curhan, G.C., Aronson, M.D., Preminger, G.M. (2021) Kidney stones in adults: Diagnosis and acute management of suspected nephrolithiasis. UpToDate. Retrieved 28th August 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/kidney-stones-in-adults-diagnosis-and-acute-management-of-suspected-nephrolithiasis

Curhan, G.C. (2021) Kidney stones in adults: Prevention of recurrent kidney stones. UpToDate. Retrieved 28th August 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/kidney-stones-in-adults-prevention-of-recurrent-kidney-stones

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