1. Dr.Bandar Al Hubaishy Urology Department KAUH
Renal stones
Dr.Bandar Al Hubaishy
Urology Department
KAUH

2. Clinical picture
Renal stones:
Small stones:
Pain
Infection
Hematouria

3. Large renal stones:
They are asymptomatic e.g. staghorn stones
Which are associated by UTI

4. Ureteric stones:
Renal colic: it is a severe colicky pain in the flank that can radiate to the groin and scrotum in male
Nausea and vomiting
Hematouria
Irritative symptoms as the stones in the distal part of the ureter

5. Physical examination Costovertebral angel tenderness
No peritoneal signs

6. Work up
Laboratory

7. Urine analysis
for evidence of hematouria and infection
CBC
for evidence of systemic infection

8. Serum electrolytes
Serum calcium
PTH
Phosphate
Uric acid

9. Metabolic screen
24 hours urinary collection offor levels of pH, calcium, oxalate, uric acid, sodium, phosphorus, citrate, magnesium, creatinine, and total volume

10. The goal of metabolic screen
To prevent future stone formation due to metabolic abrnomalities

11. Indications for metabolic screen
Residual calculi after surgical treatment
Initial presentation with multiple calculi
Initial presentation before age 30 years
Renal failure
Solitary kidney (including renal transplant)
Family history of calculi
More than one stone in the past year
Bilateral calculi

12. Imaging studies

13. KUB
Renal ultrasound
Spiral C.T abdomen without contrast
IVP

14. KUB
To detect radiopaque stones
To follow up the radiopaque stone

15. Ultrasound For radiolucent stones and for pregnant stones
To assess the presence of hydronephrosis
It can not assess the presence of ureteric stones

16. IVP It assess both function and anatomy of the renal system
Delayed nephrogram is the only hallmark for urinary tract obstruction

17. Contraindications of IVP:
Pregnancy
Pediatric
Allergy
Mettformin
Renal impairment

18. It 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

19. Spiral 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.

20. Disadvantages 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.

21. It 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.

22. MANAGEMENT

23. It depends on the site , size and the general condition of the patient
The management involve medical and surgical management

24. Renal Stones Small renal stones less than 0.6 mm: Hydration Ebimag
Follow up in the clinic with KUB every 2 weeks

25. Renal stones size 0.7mm-2cm:
ESWL
Hydration
Analgesic
KUB follow up in the clinic

26. Renal stones bigger than 2 cm
Percutaneous nephrostolithotomy (PCNL)

27. Ureteric Stones
Non obstructing stone:
Hydration
Ebimag
Analgesic

28. Obstructing ureteric stone
If the patient is stable, ureteroscopy and lithotripsy
If the patient is not stable,do double j stent insertion or nephrostomy tube to decompress the obstruction

29. THANK YOU