inpatient / nephrology


Last Updated: 1/21/2023

# Nephrolithiasis

-- 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 ***.

-- 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

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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

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