Kidney stone disease
Revision as of 12:17, 8 November 2018 by Mikael Häggström (talk | contribs) (Merged from Urolithiasis)
Author:
Mikael Häggström [notes 1]
Kidney stone disease, also known as urolithiasis, is when a calculus (kidney stone) occurs in the urinary tract.[1]
Contents
Planning
Need for imaging
Imaging is indicated in cases of flank pain and hematuria.[2]
Choice of modality
File:Algorithm for kidney stone disease.png
Algorithm for kidney stone disease, developed in the US.[3]
- Ultrasonography of kidney stone disease is the first-line imaging modality for patients <14 years of age and those who are pregnant. It is also the first-line investigation for thin (BMI <30) patients and there is a strong suspicion of kidney stone disease.[2] In the algorithm at right, hydronephrosis may count as a diagnostic finding of urolithiasis.
- CT of kidney stone disease is recommended for older patients, as well as those who have higher BMI and/or less specific findings.[2]
Evaluation
- Ultrasonography of renal stone located at the pyeloureteric junction.jpg
Renal ultrasonograph of a stone located at the pyeloureteric junction with accompanying hydronephrosis.
- CT measurement of kidney stone in soft tissue and bone window.jpg
Measurement of a 5.6 mm large kidney stone in soft tissue window (at left, with width of 400 HU, and center at 50 HU) versus skeletal window (right, W1800,C400). 145 HU is regarded as an appropriate cutoff to distinguish a stone from surrounding tissue.[4]
Objectives of the evaluation include:[5]
- Presence of stones within the urinary tract
- Complications such as hydronephrosis (See: Hydronephrosis)
- Measure the size of stones. Proper sizing of a stone is important at around 5 mm and above, since smaller stones generally pass spontaneously.[notes 2] Sizing of larger stones is also important in order to decide which treatment to choose.[notes 3]
- Confirm any stone passage
- Assess the stone burden
Report
- Stone size(s) and location(s) along the urinary tract.
- Hydronephrosis and its severity
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
- ↑ Ureteric stones less than 5 mm in diameter pass spontaneously in up to 98% of cases, while those measuring 5 to 10 in diameter pass spontaneously in less than 53% of cases.
- Gettman, MT; Segura, JW (2005). "Management of ureteric stones: Issues and controversies ". British Journal of Urology International 95 (Supplement 2): 85–93. doi:. PMID 15720341. - ↑ Small proximal ureteral calculi of less than 10 mm are best treated with shock wave lithotripsy and ureteroscopy, while those larger than 10 mm are best treated with flexible ureteroscopy combined with holmium laser lithotripsy.
- Glenn M Preminger, Section Editors:Stanley Goldfarb, Michael P O'Leary. Deputy Editor:Albert Q Lam (2018-01-19). Management of ureteral calculi. UpToDate.
References
- ↑ . Kidney Stones in Adults (February 2013). Archived from the original on 11 May 2015. Retrieved on 22 May 2015.
- ↑ 2.0 2.1 2.2 Brisbane, Wayne; Bailey, Michael R.; Sorensen, Mathew D. (2016). "An overview of kidney stone imaging techniques ". Nature Reviews Urology 13 (11): 654–662. doi:. ISSN 1759-4812.
- ↑ Brisbane, Wayne; Bailey, Michael R.; Sorensen, Mathew D. (2016). "An overview of kidney stone imaging techniques ". Nature Reviews Urology 13 (11): 654–662. doi:. ISSN 1759-4812.
- ↑ Lidén, Mats; Thunberg, Per; Broxvall, Mathias; Geijer, Håkan (2015). "Two- and three-dimensional CT measurements of urinary calculi length and width: a comparative study ". Acta Radiologica 56 (4): 487–492. doi:. ISSN 0284-1851.
- ↑ J Kevin Smith, Mark E Lockhart, Nicole W Berland and Philip J Kenney (2015-10-27). Urinary Calculi Imaging. Medscape.
