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This month’s @ASPNeph Imaging Webinar was about #RenalCalculi #LetsROCK!
Here's what I learned!
#Medtweetorial #nephtwitter #kidneystones
This month’s @ASPNeph Imaging Webinar was about #RenalCalculi #LetsROCK!
Here's what I learned!
#Medtweetorial #nephtwitter #kidneystones
Let’s start with a poll! Which of the following is true about kidney stones in children?
Lets quickly dive into a couple of definitions
♦️Nephrolithiasis: Deposition of stones in kidney collecting system
♦️Nephrocalcinosis: Deposition of calcium in the kidney parenchyma and tubules
♦️Nephrolithiasis: Deposition of stones in kidney collecting system
♦️Nephrocalcinosis: Deposition of calcium in the kidney parenchyma and tubules
What are kidney stones made of?
♦️Calcium oxalate (45-65%)
♦️Calcium Phosphate (14-30%)
♦️Struvite (13%)
♦️Cystine (5%)
♦️Uric acid (4%)
♦️Other (4%)
♦️Calcium oxalate (45-65%)
♦️Calcium Phosphate (14-30%)
♦️Struvite (13%)
♦️Cystine (5%)
♦️Uric acid (4%)
♦️Other (4%)
Why do we care about kidney stones in children?
Stones can be-
⚡️Symptomatic (pain, infection, bleeding, obstruction)
⚡️Could be a marker of underlying metabolic or structural problems
⚡️Can recur
⚡️Can be associated with progressive worsening of kidney function
Stones can be-
⚡️Symptomatic (pain, infection, bleeding, obstruction)
⚡️Could be a marker of underlying metabolic or structural problems
⚡️Can recur
⚡️Can be associated with progressive worsening of kidney function
What are the metabolic causes of kidney stones?
Metabolic abnormalities can result from genetic or dietary factors. These are some of the metabolic causes of kidney stones in children👇👇
What is true about infection stones?
Struvite stones can enlarge & fill the renal calyces, producing a "staghorn" appearance
Don’t forget to take medication history which can lead to stones in 1-2% cases
Kidney stone can present with:
⚡️Abdominal pain
⚡️Classic loin to groin pain
⚡️Haematuria (mostly painful, sometimes painless)
⚡️UTI
⚡️Obstruction
⚡️AKI
⚡️CKD
⚡️Incidental finding ( nephrocalcinosis/ nephrolithiasis)/Asymptomatic
⚡️Abdominal pain
⚡️Classic loin to groin pain
⚡️Haematuria (mostly painful, sometimes painless)
⚡️UTI
⚡️Obstruction
⚡️AKI
⚡️CKD
⚡️Incidental finding ( nephrocalcinosis/ nephrolithiasis)/Asymptomatic
Imaging in kidney stones:
🔸Ultrasound → non invasive, Acoustic shadowing/Obstruction
🔹CT (Helical, non contrast): if ureteric stone suspected
🔸Abdominal X ray (***Purine stones can be radiolucent)
🔸DMSA Scan- evaluate renal function
🔸Ultrasound → non invasive, Acoustic shadowing/Obstruction
🔹CT (Helical, non contrast): if ureteric stone suspected
🔸Abdominal X ray (***Purine stones can be radiolucent)
🔸DMSA Scan- evaluate renal function
Further stone work up involves clinical history, blood and 24-hr or spot urine tests. Here is my infographic on paediatric kidney stone work up👇👇
Age dependent normal values for Spot urines may be analysed as creatinine ratios (mmol/mmol) with 95% centile normal values. 24 hr urine collection can be done in older child.
Don't forget to look for urine crystals renalfellow.org
🔴Calcium oxalate dihydrate: Bipyramidal/envelope
🔴Calcium oxalate monohydrate: Dumbell
🔴Cystine: Hexagonal
🔴Struvite: Coffin-lid
🔴Uric acid crystals: Pleomorphic
🔴Calcium oxalate dihydrate: Bipyramidal/envelope
🔴Calcium oxalate monohydrate: Dumbell
🔴Cystine: Hexagonal
🔴Struvite: Coffin-lid
🔴Uric acid crystals: Pleomorphic
Management of stones involves:
♦️Acute Management
♦️ Urological procedure if indicated
♦️Work up for specific cause & targeted Rx to prevent recurrence
Here is my infographic on management of paediatric kidney stones👇👇
♦️Acute Management
♦️ Urological procedure if indicated
♦️Work up for specific cause & targeted Rx to prevent recurrence
Here is my infographic on management of paediatric kidney stones👇👇
That’s all folks!
For a case-based clinical discussion with radiology expert login to @ASPNeph website, June webinar. Answer questions to get #MOC2credits #Membereducation #ASPNFOAMgroup
Until next time…
@RoshanPGeorgeMD @basalely @drM_sudha @priti899
For a case-based clinical discussion with radiology expert login to @ASPNeph website, June webinar. Answer questions to get #MOC2credits #Membereducation #ASPNFOAMgroup
Until next time…
@RoshanPGeorgeMD @basalely @drM_sudha @priti899
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