Nephrolithiasis resident survival guide
Nephrolithiasis is the presence of stones, in the kidneys or the ureters, formed by different substances. The common presentation is a severe colic type pain in the abdomen flanks, sometimes including nausea, vomits or even fever.
Life Threatening Causes
- Renal Obstruction
- Renal Isquaemia
- Renal Impairment
- Metabolic acidosis
- Previous chemotherapy for Lymphoma and Leukemia
- Urine Infection
- Drug related stones
|Characterize the symptoms: |
|Obtain a detailed history: |
❑ History of kidney stones
❑ Diseases such as:
❑ Drug treatments and regular intake:
|Examine the patient: |
|Order labs and tests: |
|Initial Management |
❑ Ureter Obstruction:
|Spontaneous passage||Elective intervention if the has not passed after 2 - 4 weeks||Intervention|
|Kidney Stone||Treatment and future prevention|
|Calcium Oxalate stones||❑Thiazide Diuretics |
|Calcium Phosphate stones||❑Acidify urine|
❑Perform a pregnancy test on women
|Cystine stones||❑Alkalize urine|
|Struvite stones||❑Acidify urine|
|Uric acid stones||❑Alkalize urine|
|Acidify urine||❑Betaine (650mg three times/day with meals) |
❑Cranberry juice (16oz/day)
|Alkalinize urine||❑Potassium citrate (10-20mEq with meals|
❑Calcium citrate (1g/day with meals)
|Extracorporeal shock wave lithotripsy||❑Renal stones <2cm |
❑Ureteral stones <1cm
|Ureterorenoscopy||❑Renal stones <2cm |
|Percutaneous nephrolithotomy||❑Renal Stones >2cm |
❑Proximal ureteral stones >1cm
- Perform a metabolic evaluation in patients with risk factors for stone recurrence
- Family history of nephrolithiasis
- Presence of biliary stone disease
- Stones are formed from cysteine, uric acid or calcium phosphate
- The patient is a child
- Administer tamsulosin and corticosteroids to help stones pass quicker and with less analgesics.
- Proceed intravenously in patients who are unable to take oral fluids or oral medications and with hypotension.
- Do not recommend calcium restrictions, as the may increase the urinary oxalate excretion.
- Do not administer NSAIDs when extracorporeal shock lithotripsy is planned, as it may increase the risk of perinephric bleeding.
- Do not perform extracorporeal shock lithotripsy in women who want to have children, percutaneous nephrolithotomy is a safer option.
- Hall PM (2009). "Nephrolithiasis: treatment, causes, and prevention". Cleve Clin J Med. 76 (10): 583–91. doi:10.3949/ccjm.76a.09043. PMID 19797458.
- Frassetto L, Kohlstadt I (2011). "Treatment and prevention of kidney stones: an update". Am Fam Physician. 84 (11): 1234–42. PMID 22150656.
- Miller NL, Lingeman JE (2007). "Management of kidney stones". BMJ. 334 (7591): 468–72. doi:10.1136/bmj.39113.480185.80. PMC 1808123. PMID 17332586.
- Portis AJ, Sundaram CP (2001). "Diagnosis and initial management of kidney stones". Am Fam Physician. 63 (7): 1329–38. PMID 11310648.