Master Nephrolithiasis Diagnosis and Management with Picmonic for Medicine

With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing.

Nephrolithiasis Diagnosis and Management

Kidney-throwing Stone with Diagnostic-computer and Manager
DikeHAfifi
Nephrolithiasis can be diagnosed by urinalysis with culture, non-contrast CT, and/or ultrasonography. Stones are treated based on size. Stones less than 10 mm are treated with conservative management. 10-20 mm stones are treated with ESWL or ureteroscopy, and stones above 20 mm are treated surgically.
10 KEY FACTS
DIAGNOSIS
Urinalysis with Culture
Urinal with Urinalysis-cup and Petri-dish

Urinalysis with culture can aid in the diagnosis of nephrolithiasis. Microscopic or gross hematuria is found in 85% of patients with nephrolithiasis. The presence of white blood cells (WBCs), bacteria, crystals, and altered urinary pH can point to a particular etiology. Elevated urinary pH can be the result of infection or colonization by urease producing organisms. A urinary pH below 5 predisposes one to uric acid stones.

Noncontrast CT
Nun-Contrast-con Cat-scanner

Non-contrast CT scan is the most frequently recommended test to visualize stones with a sensitivity of 95-100%. It has advantages compared to other imaging studies, including detection of other possible abnormalities (e.g., renal carcinoma, aortic aneurysm, pancreatitis), avoiding IV contrast, and detection of stone composition (which is useful to predict the response of ESWL).

Ultrasound
Ultrasound-machine

Ultrasound is another imaging study that helps to visualize small stones, especially in patients who should limit radiation exposure, such as pregnant women and children. Stones less than 5 mm in size are difficult to visualize and may require CT. Clinical suspicion is raised in the setting of perirenal urinoma (leaked urine outside the urinary tract), hydroureter >6mm in size or if the stone is visualized directly.

MANAGEMENT
< 10 mm
Less Than (10) Tin

Most stones less than <10 mm can be passed spontaneously within 4 to 6 weeks. Supportive care can be used to accelerate the excretion of the stone (e.g. hydration).

Supportive Care
Supportive IV bags

Supportive care includes hydration, painkillers (e.g., NSAIDs), antiemetics, and antispasmodics. Antispasmodics, such as alpha-blockers (e.g., doxazosin and tamsulosin) and calcium channel blockers (e.g., nifedipine), can be used to accelerate stone passage. These drugs work by relaxing the smooth muscle of the ureter, and are commonly used for distal ureter stones 5-10 mm.

10-20 mm
(10) Tin to (20) Dollar-bill

10-20 mm stones are usually treated with extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy.

Extracorporeal Shock Wave Lithotripsy
Lizard-gypsy

ESWL utilizes shock waves to destroy stones by tensile and compressive forces. The shattered stone will be excreted with urine. ESWL is recommended in symptomatic patients with a total stone burden ≤ 20 mm.

Ureteroscopy
U-rooster-scope

Ureteroscopy is a more invasive procedure than ESWL and is used if ESWL fails. It uses a small semi-rigid or flexible scope to visualize the stone and enters via the urethra to the ureter and/or kidneys. Stones are destroyed with a laser and/or gripped and removed.

> 20 mm
Greater Than (20) Dollar-bill

Most stones >20 mm are treated with surgery.

Surgery
Surgeon

Surgery is indicated in cases refractory to ESWL and Ureteroscopy or for stones > 20 mm. Open/ laparoscopic/ robotic surgery (nephrolithotomy / pyelolithotomy / ureterolithotomy) should not be recommended as the first-line treatment except for large or complex stones, in rare cases of anatomic abnormalities, and for patients who need concomitant reconstruction.

Unlock all 10 facts & definitions with Picmonic Free!

JOIN FREE

Take the Nephrolithiasis Diagnosis and Management Quiz

Picmonic's rapid review multiple-choice quiz allows you to assess your knowledge.

START QUIZ NOW

It's worth every penny

Our Story Mnemonics Increase Mastery and Retention

Memorize facts with phonetic mnemonics

Unforgettable characters with concise but impactful videos (2-4 min each)

Ace Your Medical (MD/DO) Classes & Exams with Picmonic:

Over 1,040,000 students use Picmonic’s picture mnemonics to improve knowledge, retention, and exam performance.

Choose the #1 Medical (MD/DO) student study app.

Picmonic for Medical (MD/DO) covers information that is relevant to your entire Medical (MD/DO) education. Whether you’re studying for your classes or getting ready to conquer the USMLE Step 1, USMLE Step 2 CK, COMLEX Level 1, or COMLEX Level 2, we’re here to help.

Works better than traditional Medical (MD/DO) flashcards.

Research shows that students who use Picmonic see a 331% improvement in memory retention and a 50% improvement in test scores.