Tuesday 1 June 2010

Renal calculi -Important points

http://amcexams.blogspot.com/?spref=gb


■ Abdominal examination is
most rewarding after ensuring
adequate analgesia.
■ Plain KUB has a sensitivity of
only 45-59% and a specificity
as low as 77% – it cannot be
used to rule in or rule out the
diagnosis of ureteric calculi.
■ Infection with obstruction
mandates urgent
decompression.
■ There is evidence of
permanent nephron loss within
72 hours of complete
obstruction.
■ The likelihood of spontaneous
stone passage is determined
by stone size and position.
■ Fifteen to twenty per cent of
all patients with ureteric
calculi will require intervention
using ESWL, ureteroscopy or
percutaneous nephrolithotomy.

Renal calculi -indictions for early intervention

1.Obstruction with evidence of infection-urgent decompression.
2.larger calculi -more than 6mm
3.Bilateral obstruction.
4.An obstructed solitary or transplanted kidney.
5.Renal impairment.(review the definition of renal impairment)
6.Ongoing unacceptable discomfort.

Haematuria

Haematuria

(usually
microscopic but sometimes
frank)
occurs in 95% of
patients with renal colic on day
one and 65% by day three,
but
up to 87% of patients with
AAA rupture will also have
haematuria.

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