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Renal Colic (Risk factors (Dehydration, Urinary pH, Drugs: Calcium/ Vit D…
Renal Colic
Risk factors
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Drugs: Calcium/ Vit D supplement's, protease inhibitors, diuretics
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Diet: Urate, oxalate, animal protein,
Diseases that alter the volume, concentration and ions present in urine. For example, Crohn's disease, gout, cystic fibrosis
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Symptoms
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Pain can radiate to flank, groin, and testes or labia majora
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Aetology
Renal stones are crystalline mineral depositions that form from microscopic crystals in the loop of Henle, distal tubules or the collecting duct.
Can be caused by elevated levels of urinary solutes such as calcium, uric acid, oxalate and sodium as well as decreased levels of stone inhibitors such as citrate and magnesium.
Stones usually obstruct at one of three sites. The vesico-ureteric junction (VUJ), the mid-ureter where the ureter crosses the iliac vessels and the pelvic-ureteric junction (PUJ).
Prevalence
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estimated 12% of men and 6% of women will have an episode of renal colic at some point in their life
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Definition
Renal colic describes the pain arising from obstruction of the ureter. The pain is caused by spasm of the ureter around the stone, causing obstruction and distension of the ureter.
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CT KUB provides all the necessary information on the position and size of the stone.
Ultrasound is non invasive with no exposure to radiation.
Plain X-ray
Routine biochemical and haematological tests to assess renal function and exclude metabolic causes.
Urine culture to detect infection.
Analgesia - NSAID most effective
A stone less than 5mm should pass easily.
Lower ureteric stones are more likely to pass than higher ones.
Immediate treatment requires for ongoing pain, renal obstruction or signs of sepsis.
Extracorporeal shockwave lithotripsy (ESWL) focuses external shockwaves that break up stones - effective in stones up to 2cm.
Other stones ca be visualised by ureterorenoscopy (URS) and stones broken up using holmium laser or removed intact using Dormia wire basket.
Stones that are unlikely to pass (even if broken up) are best treated by direct puncture of the kidney, insertion of sheath and removed under vision of nephroscope.
Large staghorn calculi filling the entire collecting system can be treated by percutaneous nephrolithotripsy (PCNL) with or without ESWL.
In patients with acute obstruction and sepsis, or renal impairment, decompression of the kidney is done via stent insertion or percutaneous nephrostomy is required.
Rarely large stones are require open suprapubic cystolithotomy
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