Stones: Evaluation and Medical Management: Difference between revisions
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=== Laboratory === | === Laboratory === | ||
* '''Urinalysis +/- culture''' | |||
** '''Urinalysis should include pH''' | ** '''Urinalysis should include pH''' | ||
*** '''pH > 7.0 is suggestive of infection lithiasis or RTA''' | *** '''pH > 7.0 is suggestive of infection lithiasis or RTA''' | ||
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*** Many infected calculi will harbour bacteria even after treatment with broad-spectrum antibiotics | *** Many infected calculi will harbour bacteria even after treatment with broad-spectrum antibiotics | ||
*** Half of infected calculi grow bacterial cultures that are different from the preoperative urine specimen | *** Half of infected calculi grow bacterial cultures that are different from the preoperative urine specimen | ||
* Urine microscopy for crystals may provide clues to diagnosis | *'''Serum metabolic panel''' | ||
** Preoperative serum chemistries are important because they may provide clues to underlying serious diseases such as renal tubular acidosis or hypoparathyroidism or other metabolic derangements | |||
** '''Assessment of underlying renal function is necessary''' | |||
* '''Urine microscopy for crystals may provide clues to diagnosis''' | |||
**Insert urine microscopy table | **Insert urine microscopy table | ||
*Stone composition, if available | *'''Stone composition, if available''' | ||
**Can direct metabolic investigation or potentially obviate the need for a complete metabolic evaluation | **Can direct metabolic investigation or potentially obviate the need for a complete metabolic evaluation | ||
=== Extensive Diagnostic Evaluation === | === Extensive Diagnostic Evaluation === | ||
* Includes one or two 24-hour urine collections | * '''Includes one or two 24-hour urine collections''' | ||
*Indications for a metabolic stone evaluation | *'''Indications for a metabolic stone evaluation''' | ||
*# Recurrent stone formers | *'''<span style="color:#ff0000">AUA (7):</span>''' | ||
*# | *#'''<span style="color:#ff0000">Recurrent stone formers</span>''' | ||
*# | *#'''<span style="color:#ff0000">Family history of stone disease</span>''' | ||
*#'''<span style="color:#ff0000">Malabsorptive intestinal disease or resection</span>''' | |||
*#'''<span style="color:#ff0000">Recurrent UTIs</span>''' | |||
*#'''<span style="color:#ff0000">Obesity</span>''' | |||
*#'''<span style="color:#ff0000">Medical conditions predisposing to stones (e.g., RTA Type 1, primary hyperparathyroidism, gout, diabetes mellitus type)</span>''' | |||
*#'''<span style="color:#ff0000">Solitary kidney</span>''' | |||
*Included in other lists | |||
*# Pathological skeletal fractures | *# Pathological skeletal fractures | ||
*# Osteoporosis | *# Osteoporosis | ||
*# Infirm health (unable to tolerate repeat stone episodes) | *# Infirm health (unable to tolerate repeat stone episodes) | ||
*# Anatomic abnormalities | *# Anatomic abnormalities | ||
*# Stones composed of cystine, uric acid, and struvite | *# Stones composed of cystine, uric acid, and struvite | ||