Abstract Medical expulsion therapy has been shown to be a useful adjunct to observation in the management of ureteral stones. Alphaadrenergic receptor antagonists have been studied in this role. Alpha-1 receptors are located in the human ureter, especially the distal ureter. Alpha-blockers have been demonstrated to increase expulsion rates of distal ureteral stones, decrease time to expulsion, and decrease need for analgesia during stone passage. Alpha-blockers promote stone passage in patients receiving shock wave lithotripsy, and may be able to relieve ureteral stent-related symptoms.
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Adapted from Coll et al. A literature review by Tang et al. Direct Cellular Toxicity: studies have demonstrated that interaction of calcium oxalate with epithelial cells of the kidney results in mitochondrial dysfunction, release of oxygen free radicals, and subsequently cell death.
CT is a widely accepted diagnostic modality for nephrolithiasis; however, due to risk of radiation, other modalities such as bedside ultrasound have been investigated. A recent study compared point of care ultrasound POCUS to radiology-performed ultrasound and CT scan and concluded that ultrasound is a good initial diagnostic test for nephrolithiasis.
Although ultrasound is poor at detecting stones, research shows that ultrasound is both specific and sensitive for detecting hydronephrosis 14 which can help clinicians quickly stratify their patients and expedite management decisions. Hydronephrosis indicates obstruction which is a threat to renal blood flow.
A young healthy patient without any signs of renal impairment or infection can be discharged home with urology follow-up within 1 week. Patients that do not meet the above criteria will benefit from urology consult in the Emergency Department.
Save multiple still images in each orientation. Left kidney is more cephalad and posterior than the right kidney and can likely be viewed in posterior axillary line and in lateral decubitus position Bladder view: place probe in suprapubic area; remember to get 2 views bladder volume can be estimated with formula 0. Do not misdiagnose the pyramids as hydronephrosis: pyramids are located just below cortex and are not connected to each other whereas the collecting system is in the center and should be hyperechoic in the absence of hydronephrosis Do not misdiagnose renal cysts as hydronephrosis: renal cysts are usually not located in renal pelvis which is in the center; they are usually peripheral Common causes of false positives: pregnancy causes non-pathological hydronephrosis due to ureteral compression Common cause of false negatives: severe dehydration can cause a false negative scan notice the anechoic renal pyramids in periphery Image courtesy ultrasoundpaedia.
Diagnosis and acute management of suspected nephrolithiasis in adults. Available at : www. Annals of emergency medicine. Ultrasound detection of obstructive pyelonephritis due to urolithiasis in the ED. The American Journal of Emergency Medicine. Kalra O. Approach to a patient with urosepsis. Journal of Global Infectious Diseases. Alternative diagnoses to stone disease on unenhanced CT to investigate acute flank pain. Emergency radiology.
Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol. Anesthesiology and Pain Medicine. Lisander B. Evaluation of the analgesic effect of metoclopramide after opioid-free analgesia. British journal of anaesthesia. Urologia Internationalis. Tamsulosin hydrochloride vs placebo for management of distal ureteral stones: a multicenter, randomized, double-blind trial.
Archives of internal medicine. A systematic review of medical therapy to facilitate passage of ureteral calculi. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. American Journal of Roentgenology. Guidelines on Urolithiasis.
European Association of Urology. Accessed October 31, Ultrasonography by emergency physicians in patients with suspected ureteral colic. The Journal of emergency medicine. Metoclopramide Primperantextregistered in the Treatment of Ureterolithiasis. Urologia internationalis. Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis. New England Journal of Medicine. Academic Emergency Medicine. The Journal of Urology. Hoffmann B, Blok B. Renal Ultrasound. Noble V, Nelson B.
Cambridge: Cambridge University Press; Kidney Stones: American Urological Association. Tang X, Lieske J. Acute and chronic kidney injury in nephrolithiasis. Current Opinion in Nephrology and Hypertension. Association between chronic kidney disease and urinary calculus by stone location: a population-based study. BJU International. Baun K, Easter J.
Elsevier Health Sciences; Chapter Urologic Stone Disease.
Use of drugs for nephrolithiasis
References The incidence of nephrolithiasis kidney stones is rising worldwide, especially in women and with increasing age. Kidney stones are associated with chronic kidney disease. Preventing recurrence is largely specific to the type of stone e. Medications, such as protease inhibitors, antibiotics, and some diuretics, increase the risk of some types of kidney stones, and patients should be counseled about the risks of using these medications. Managing diet, medication use, and nutrient intake can help prevent the formation of kidney stones.
Treatment and Prevention of Kidney Stones: An Update
Find out which of your patients can benefit. Effect of tamsulosin on stone passage for ureteral stones: a systematic review and meta-analysis. Ann Emerg Med. He is deemed appropriate for outpatient management. In addition to pain medications, should you prescribe tamsulosin? According to the most recent National Health and Nutrition Examination Survey, the population prevalence of kidney stones is 8. In fact, the European Association of Urology guideline on urolithiasis states that MET may accelerate passage of ureteral stones.
Alpha Blockers for Nephrolithiasis
Adapted from Coll et al. A literature review by Tang et al. Direct Cellular Toxicity: studies have demonstrated that interaction of calcium oxalate with epithelial cells of the kidney results in mitochondrial dysfunction, release of oxygen free radicals, and subsequently cell death. CT is a widely accepted diagnostic modality for nephrolithiasis; however, due to risk of radiation, other modalities such as bedside ultrasound have been investigated. A recent study compared point of care ultrasound POCUS to radiology-performed ultrasound and CT scan and concluded that ultrasound is a good initial diagnostic test for nephrolithiasis. Although ultrasound is poor at detecting stones, research shows that ultrasound is both specific and sensitive for detecting hydronephrosis 14 which can help clinicians quickly stratify their patients and expedite management decisions. Hydronephrosis indicates obstruction which is a threat to renal blood flow.
Nephrolithiasis: Diagnosis and Management in the ED
Author information Copyright and License information Disclaimer S. Abstract Renal stone disease often begins by renal colic. In order to manage this event adequately, several goals should be pursued: first, attenuate pain; second, favour progression and spontaneous expulsion of stones; third, prevent from obstructive and infectious complications. All of the aforementioned points pertain to medical management of this disease. Concerning prevention, it is widely agreed that pathogenesis of kidney stones is a consequence of abnormalities in urine environment, leading to a disequilibrium between promoters and inhibitors of crystallization. Therefore, the rationale for therapy is to make urine less conductive to stone formation, by both decreasing state of saturation and increasing inhibitory potential. In only some types of stone-forming salts it is possible to obtain undersaturation with the solid phase.