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Renal Stones
KEY FACTS
Terminology
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Definition: Concretion in urinary system
Imaging
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Most stones seen in kidneys & upper urinary tract
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Range in size from 1-2 mm to > 1 cm
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NECT most sensitive modality to detect stones
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Calcified density in urinary system
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Ultrasound shows hyperechoic urinary tract focus with posterior acoustic shadowing &/or twinkle artifact
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Signs of obstruction (US/CT/MR)
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Hydroureteronephrosis
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Nephromegaly
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Perinephric/periureteral edema
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Lack of ureteral jet in urinary bladder on Doppler ultrasound
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High-resistance renal artery flow on Doppler ultrasound
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Delayed renal enhancement & excretion after IV contrast administration
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Top Differential Diagnoses
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Phleboliths
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Nephrocalcinosis
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Ureteropelvic junction obstruction
Clinical Issues
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Presentations: 94% of adolescents have colicky flank pain; younger children have nonspecific symptoms (abdominal pain, nausea, vomiting, & irritability)
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Hematuria microscopic in up to 90%, gross in up to 32%
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Concomitant urinary tract infection in 8-20%
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Treatment: Depends on stone size, location, presence of obstruction, & underlying etiology
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Analgesia, ↑ fluid intake
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Up to 60% of stones < 5 mm pass spontaneously
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Surgical management required in 22%: Extracorporeal shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy
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Transverse ultrasounds of the left kidney in an adolescent with left flank pain show an echogenic focus
within the renal collecting system. With color Doppler ultrasound, there is considerable twinkle artifact
posterior to the echogenic focus, typical of a calculus.
within the renal collecting system. With color Doppler ultrasound, there is considerable twinkle artifact posterior to the echogenic focus, typical of a calculus.
Coronal NECT in the same patient shows a small nonobstructing calcified stone
in the lower pole of the left kidney. Approximately 75% of pediatric patients with renal stones have an identifiable predisposition to stone formation.
in the lower pole of the left kidney. Approximately 75% of pediatric patients with renal stones have an identifiable predisposition to stone formation.
AP radiograph of the abdomen in an adolescent shows a small calcified stone
inferior & medial to the right renal shadow
, likely in the proximal ureter.
inferior & medial to the right renal shadow , likely in the proximal ureter.
Retrograde pyelogram in the same patient shows a small filling defect
in the midportion of the right ureter at the level of the nonobstructing stone.
in the midportion of the right ureter at the level of the nonobstructing stone.
TERMINOLOGY
Synonyms
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Nephrolithiasis, nephrolith, urolithiasis, urolith, urinary stone, kidney stone, renal calculi
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