Know your renal stone.

Signs|symptoms|risk factors|Differential diagnosis|Diagnosis|Treatment:

Signs and symptoms of renal stone:

Usually, it is asymptomatic and diagnosed by general routine ultrasound examination.

• Pain is the presenting feature when a stone obstructs the renal pelvis, ureter, and urethra. Intermittent severe pain is the presenting feature. Pain comes in waves lasting twenty to sixty minutes. Pain radiates to the abdominal flank, to the groin, and to the inner side of the thigh.

[This is referred pain. There are embryological links between the urinary system, genital system, and the gastrointestinal tract, which explains the radiation of pain.]

• Fever, sweating, nausea, vomiting.
• Urinary urgency, increased frequency, hematuria.
• In neglected renal stones, hydronephrosis and deterioration of renal functions are observed.

Signs: tenderness at the costovertebral angle-renal angle.

Differential diagnosis:

Acute appendicitis,diverticulitis,pancreatitis.

Diagnosis:

·? Medical history

·? Family history

·? Complete physical examination

·? Complete blood count -CBC

·? R/E of urine-urinalysis

·? Culture and sensitivity test of urine

·? Renal function tests

·? X-ray examination of the whole abdomen-KUB.

·? Only 60% of renal stones are radioopaque-calcium phosphate, calcium oxalate, and 'magnesium ammonium phosphate' stones.

·? Cystine caliculi are faintly radiodense, and uric acid stones are usually radiolucent.

·? Intravenous pyelogram, retrograde pyelogram.

·? Ultrasonography of the whole abdomen

·? Computerized tomography –CT scan, helical CT scan.

·? MRI

Treatment:

Asymptomatic calculus –no treatment. Drinking fluid is advised so that more than two liters of urine are produced daily.

Small stones < 5 mm usually pass spontaneously.

Potassium citrate and alkali citrate increase urinary citrate and reduce the incidence of stone formation.

Symptomatic calculus –causing pain: The first line of treatment is to manage pain with paracetamol or nonsteroidal anti-inflammatory drugs or opioids.

Staghorn kidney stones are large stones in the kidney.

Surgical treatments:

·? Extracorporeal shock wave lithotripsy

·? Ureteroscopy

·? Percutaneous nephrolithotomy

·? Manual surgical removal of stone.

·? Urography contrast radiography of the urinary tract.

·? Pyelography is contrast radiography of the urinary tract. Urography and Pyelography are the same.

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