Kidney Stones

By: Michael Hawkins

This presentation is on kidney stones. The objectives are to learn about the presentation of kidney stones, the different types of kidney stones, and how they appear on imagining. So there are four main types of kidney stones. There's calcium, which makes up the majority of the types you'll see, ammonium magnesium phosphate, uric acid, and cystine.

When patients present with kidney stones they're going to complain of flank pain that varies in intensity. It comes and goes but it starts at their flank and moves down towards their groin. They may also present with hematuria and other symptoms of a UTI. So calcium stones, which are seen up here in the corner occur at a high ph and they'll start to precipitate. At a low ph you'll get calcium oxalate stones. Usually the calcium oxalate stones are linked to drinking ethylene glycol, or antifreeze, Vitamin C abuse, and Crohn's Disease.

Both calcium stones occur because of hypercalciuria and hyperparathyroidism. And in the urine you're going to get dumbbell-shaped crystals. And you treat recurring stones with thiazides and citrates. Ammonium magnesium phosphate stones. These form with increased ph. These stones are caused by infections with urease positive bugs, like Proteus, Staph, Klebsiella, that hydrolyze urea to ammonia, which is urine alkalinization. They can form staghorn calculi.

Uric acids stones form with decreased ph, decreased urine volume, hyperuricemia, and arid climates. The crystals form rhomboids or rosettes. These are visible on CT and ultrasound, but not X-ray. You treat these with alkalinization of the urine.

Kidney Stones

Cystine stones form in a decreased ph. You may only see them in children secondary to cystinuria. They form hexagonal crystals in the urine and they're treated by alkalinization of urine and hydration. On image, calcium, ammonium, and magnesium phosphate, and cystine stones are radiopaque, which means you can see them on X-rays. Uric acid stones are radiolucent. They cannot be seen. So this is pretty easy to remember. Just always know you cannot see uric acid stones.

They are radiolucent. Everything else you can see. Question. A 22-year-old male is diagnosed with a calcium oxalate stone. He was previously healthy before and lab tests revealed no urgent abnormalities.

He begins to ask the emergency medicine doctor what is the best way he can prevent having anymore stones. What is the best answer? Make sure you stay hydrated, increase daily calcium intake by 50%, limit all calcium in your diet, there's nothing you can, or increase dairy in your diet? So the answer for this one is make sure you stay hydrated. So you definitely don't want to tell somebody to increase their calcium because that would precipitate more stones. And you wouldn't ever want to tell anybody to decrease their calcium.

There is obviously something you can do to decrease your chance of getting kidney stones. And dairy, really, wouldn't have anything to do. It would probably increase your Vitamin D, which would, therefore, possibly increase your calcium. So that wouldn't really be helpful. But staying hydrated, for the most part, can decrease your chances of getting kidney stones.

That's it.

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