inpatient / nephrology
Nephrolithiasis
# Nephrolithiasis
Assessment:
-- History: *** RFs: male, 45-70 years old, poor PO intake, loop diuretic use, FHx, obesity, DM, CKD; renal transplant
-- Clinical/Exam: *** fevers, dysuria with pain radiating to the pubic region (renal colic), CVA tenderness, blood in urine, nausea/vomiting,
-- Data: *** WBC, Hgb, creatinine, UA
-- Etiology/DDx: *** Causes of stones: low urine volume, hypercalciuria, bacteria, sodium intake, pH urine
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
Plan:
-- IVF: ***
-- Pain: *** NSAIDs first line, then opioids like morphine
-- Consider Alpha-blockers (tamsulosin 0.4mg PO daily) if >5mm
-- Imaging: CT non-con > US
-- Consult urology for stones >10mm or c/f infection for lithotripsy vs surgical planning
-- Guidance: *** fluid intake >2.5L/day, low Na diet, 24-hour urine with litholink, avoid thiazides
PDF coming soon!
Clinical Pearls
- Calcium oxalate > calcium phosphate > urate / struvite > cysteine
- High levels of calcium, uric acid, and oxalate in the urine all promote stone formation
- IV fluids have not been shown to help pass stones or improve pain symptoms - mostly give to replace losses for nausea/vomiting or poor PO intake
- Renal colic is something of a misnomer since the pain usually does not remit
Trials and Literature
Other Resources
