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Nephrolithiasis (Image (IVU (Failure of distal flow of contrast, Standing…
Nephrolithiasis
Image
IVU
Failure of distal flow of contrast
Standing column of contrast
Clubbing of calyces
Delayed, dense nephrogram
Visible stone
Ask to see KUB control film
90% of stones radio-opaque
Technical
600x radiation dose of KUB
Urograffin contrast injection
Immediate film + 30min + 1h
Contraindications to IVU
Contrast allergy
Pregnancy
Severe asthma
Metformin
Significant renal impairment
Alternative
Non-contrast CT-KUB is gold standard
99% of stones visible
Mx
Initial
Analgesia
IV or oral fluids
Conservative: <5mm in lower 1/3 of ureter
90-95% pass spontaneously
Sieve urine for OPD stone analysis
Medical Expulsive Therapy: 5-10mm
Nifedipine or tamsulosin
Most pass w/i 48h
Active Stone Removal
Indications
Stones >10mm
Persistent obstruction
Renal insufficiency
Infection
Procedures
Extracorporeal shockwave lithotripsy
Ureterorenoscopy + Dormier basket removal
Percutaneous nephrolithotomy
Lap or open stone removal
Febrile w/ Renal Obstruction
Surgical emergency
Percutaneous nephrostomy or ureteric stent
IV Abx: e.g. cefuroxime 1.5g IV TDS
Stone Types
Calcium oxalate: 75%
Triple phosphate (struvite): 15%
Ca Mg NH4 – phosphate
May form staghorn calculi
A/w proteus infection
Urate: 5% (radiolucent)
Double if confirmed gout
Cystine: 1% (faint)
A/w Fanconi Syn
Pathophysiology
↑ concentration of urinary solute
↓ urine volume
Urinary stasis
Common Anatomical Sites
Pelviureteric junction
Pelvic brim
Vesicoureteric junction
Ureteric Colic
Severe loin pain radiating to the groin
A/w n/v
Pt. cannot lie still