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Kidney stone disease: Difference between revisions
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<section begin="urology stone" /><section begin="urology colic" /><section begin="radiology" />'''Kidney stone disease''', also called '''nephrolithiasis''' or '''urolithiasis''', refers to the presence of symptomatic kidney stones in the urinary tract. When stones are present in the ureter it may be called '''ureterolithiasis''', while stones in the bladder are usually simply called '''bladder stones''' or '''bladder calculi'''. It's a relatively common condition, with a lifetime prevalence of 10 - 20 percent.<section end="radiology" /> | <section begin="urology clinical" /><section begin="urology stone" /><section begin="urology colic" /><section begin="radiology" />'''Kidney stone disease''', also called '''nephrolithiasis''' or '''urolithiasis''', refers to the presence of symptomatic kidney stones in the urinary tract. When stones are present in the ureter it may be called '''ureterolithiasis''', while stones in the bladder are usually simply called '''bladder stones''' or '''bladder calculi'''. It's a relatively common condition, with a lifetime prevalence of 10 - 20 percent.<section end="radiology" /> | ||
Many have asymptomatic kidney stones (which is not considered kidney stone disease), but in some cases stones can cause [[Obstructive uropathy|urinary obstruction (obstructive uropathy)]] and resulting damage to the kidney, as well as episodes of severe pain called renal colic.<section end="urology colic" /> | Many have asymptomatic kidney stones (which is not considered kidney stone disease), but in some cases stones can cause [[Obstructive uropathy|urinary obstruction (obstructive uropathy)]] and resulting damage to the kidney, as well as episodes of severe pain called renal colic.<section end="urology colic" /><section end="urology clinical" /> | ||
== Epidemiology == | == Epidemiology == | ||
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Cysteine stones occur in people with genetically determined defects in renal transport of cysteine. Acidic urine also increases the risk for cysteine stones. | Cysteine stones occur in people with genetically determined defects in renal transport of cysteine. Acidic urine also increases the risk for cysteine stones. | ||
The renal colic pain associated with kidney stones is thought to occur | The renal colic pain associated with kidney stones is thought to occur when stones enter the ureter, causing distension of the kidney capsule due to urinary obstruction, and due to ureteric spasm. Stones in the renal pelvis themselves are usually asymptomatic.<section end="urology stone" /><section begin="urology colic" /><section begin="urology clinical" /> | ||
<section end="urology stone" /><section begin="urology colic" /> | |||
== Clinical features == | == Clinical features == | ||
Kidney stones may be asymptomatic, especially if they are in the renal pelvis. | Kidney stones may be asymptomatic, especially if they are in the renal pelvis. Kidney stones may also cause haematuria. | ||
=== Renal colic === | === Renal colic === | ||
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A presumptive diagnosis may be made when the patient has typical renal colic, as kidney stone is highly likely in that case. | A presumptive diagnosis may be made when the patient has typical renal colic, as kidney stone is highly likely in that case. | ||
Haematuria on [[urine analysis]] is seen in most cases of kidney stone (90%), but absence of haematuria does not exclude the diagnosis. | Haematuria on [[urine analysis]] is seen in most cases of kidney stone (90%), but absence of haematuria does not exclude the diagnosis. It may be necessary to measure the serum calcium and uric acid level, as well as the [[Kidney function tests|kidney function]].<section begin="radiology" /> | ||
<section begin="radiology" /> | |||
=== Imaging === | === Imaging === | ||
A low-dose non-contrast [[CT]] is usually the first choice as this has little radiation exposure and can detect the majority of stones. [[Ultrasonography]] is a reasonable alternative first choice, especially in pregnant and children, but many stones are not visible on ultrasound (70% sensitive and specific). Kidney, ureter, bladder (KUB) [[radiography]] was previously widely used, but it is not sensitive and so is rarely used nowadays. | A low-dose non-contrast [[CT]] is usually the first choice as this has little radiation exposure and can detect the majority of stones. [[Ultrasonography]] is a reasonable alternative first choice, especially in pregnant and children, but many stones are not visible on ultrasound (70% sensitive and specific). Kidney, ureter, bladder (KUB) [[radiography]] was previously widely used, but it is not sensitive and so is rarely used nowadays. | ||
If the stone causes urinary obstruction, one may see [[hydronephrosis]] and dilated proximal ureters. | If the stone causes urinary obstruction, one may see [[hydronephrosis]] and dilated proximal ureters.<section end="radiology" /><section end="urology clinical" /> | ||
<section end="radiology" /> | |||
== Management == | == Management == | ||
Asymptomatic stones need no management or follow-up. | Asymptomatic stones need no management or follow-up. | ||