3Large renal stones:They are asymptomatic e.g. staghorn stonesWhich are associated by UTI
4Ureteric stones:Renal colic: it is a severe colicky pain in the flank that can radiate to the groin and scrotum in maleNausea and vomitingHematouriaIrritative symptoms as the stones in the distal part of the ureter
5Physical examination Costovertebral angel tenderness No peritoneal signs
9Metabolic screen24 hours urinary collection offor levels of pH, calcium, oxalate, uric acid, sodium, phosphorus, citrate, magnesium, creatinine, and total volume
10The goal of metabolic screen To prevent future stone formation due to metabolic abrnomalities
11Indications for metabolic screen Residual calculi after surgical treatmentInitial presentation with multiple calculiInitial presentation before age 30 yearsRenal failureSolitary kidney (including renal transplant)Family history of calculiMore than one stone in the past yearBilateral calculi
13KUBRenal ultrasoundSpiral C.T abdomen without contrastIVP
14KUBTo detect radiopaque stonesTo follow up the radiopaque stone
15Ultrasound For radiolucent stones and for pregnant stones To assess the presence of hydronephrosisIt can not assess the presence of ureteric stones
16IVP It assess both function and anatomy of the renal system Delayed nephrogram is the only hallmark for urinary tract obstruction
17Contraindications of IVP: PregnancyPediatricAllergyMettforminRenal impairment
18It is no longer used as the standard for the initial evaluation of a patient with a kidney stone : Up to 6 hours may be required to complete the study in the presence of severe obstruction.For optimal results, IVU requires a bowel preparation.It involves intravenous injection of potentially allergic and mildly nephrotoxic contrast material
19Spiral C.T abdomin and Pelvis without contrast It is the best initial radiographic examination for acute renal colic.Advantages of a CT scanning include the following:It can reveal other pathology (eg, abdominal aneurysms, appendicitis, cholecystis).It can be performed quickly.It avoids the use of intravenous contrast materials.
20Disadvantages of CT scanning include the following: It cannot be used to assess individual renal function.It can fail to reveal some unusual radiolucent stones, such as those caused by indinavir, which are invisible on the CT scan. Because of this possibility, IVUs with contrast should be used for patients taking indinavir.It is relatively expensive.
21It exposes the patient to a relatively high radiation dose. Precise identification of small distal stones is occasionally difficult.It is not suitable for tracking the progress of the stone over time, supporting the recommendation for KUB radiography along with the CT scan.