Kidney stones (to form)______________ inside the kidneys or ureters. If stones (to grow)________to
sufficient size before passage at least 2-3 millimeters--they can (to cause)___________obstruction of the
ureter. This can (to cause)____________severe episodic pain, most commonly felt in the flank, lower
abdomen and groin (This condition (to call)_____________renal colic). Renal colic can (to associate)
______with nausea and vomiting due to the embyrological association of the kidneys and the
intestinal tract. Recurrence rates (to estimate)______________________at about 10% per year.
Kidney stones (to be)_____usually asymptomatic until they (to obstruct)_________the flow of urine.
Symptoms can (to include)____________acute flank pain (renal colic), nausea and vomiting, restlessness,
dull pain, hematuria, and possibly fever if an infection (to be) _______present. Acute renal colic (to
describe)__________ as one of the worst types of pain that a patient can (to suffer)______________.
Some patients show no symptoms until their urine (to turn)________bloody—this may (to be)_____the
first symptom of a kidney stone. About 15% of proven kidney stone patients may not (to show)_________
even microscopic hematuria so this (not to consider)_________________________a definitive diagnostic
sign.
Diagnosis (to make)_____usually_________on the basis of the location and severity of the pain, which
(to be)_______typically colic in nature (comes and goes in spasmodic waves). Radiological imaging (to
use)___________ to confirm the diagnosis and a number of other tests can (to undertake)
_________________to help establish both the possible cause and consequences of the stone. Ultrasound
imaging (to be) _____also useful as it (to give)__________________details about the presence of
hydronephrosis (swelling of the kidney suggesting the stone (to block)
_____________________________the outflow of urine). It can also (to use)______________' to show
the kidneys during pregnancy. About 10% of stones (not to have)____________enough calcium to be
seen on standard x-rays and may (to show up)________________on ultrasound although they typically
(to see)_________________on CT scans.
Investigations typically carried out (to include)___________________:
• Microscopic study of urine, which may (to show)_____________proteins, red blood cells, pus
cells, and crystals.
• Culture of a urine sample to exclude urine infection
• Blood tests: Full blood count for the presence of a raised white cell count (Neutrophilia) suggestive of infection, a check of renal function and if raised blood calcium blood levels (hypercacaemia).
• 24 hour urine collection to measure total daily urinary volume, magnesium, sodium, uric acid, calcium, and phosphate.
90% of stones 4 mm or less in size usually (to pass)___________spontaneously, however the majority of
stones greater than 6 mm (to require)_______________ some form of intervention.
In many cases non-invasive Extracorporeal Shock Wave Lithotripsy or (ESWL) may (to use)
____________, Percutaneous nephrolithotomy or open surgery may (to be)_____necessary for large or
complicated stones or stones which (to fail)__________other less invasive attempts at treatment.
Preventive strategies (to include)__________dietary modifications and sometimes also taking drugs with
the goal of reducing excretory load on the kidneys:
• Drinking enough water to make 2 to 2.5 liters of urine per day.
• A diet low in protein, nitrogen and sodium intake.
• Taking drugs such as thiazides, potassium citrate, magnesium citrate and allopurinol depending on the cause of stone formation.
Depending on the stone formation disease, vitamin B-6 and orthophosphate supplements may (to be)_____
helpful.
