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Senior - Urology > 1 - Urinary Stone Disease > Flashcards

1 - Urinary Stone Disease Flashcards

1
Q

Urinary stone disease factoids

A

3rd MC urinary tract d/o

Male > female 2.5:1

Age 30-50’s

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2
Q

Urolithiasis?

A

Stone formation anywhere in urinary tract

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3
Q

Nephroloithiasis

A

Stones in the kidneys

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4
Q

Ureterolithiasis

A

Stones in the ureters

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5
Q

Urinary calculi

A

Polycrystalline aggregates of crystalloid and organic matrix

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6
Q

Stone formation is a result of?

A

Uninary supersaturation of solute

  • low fluid intake -> low urine volume -> high concentrations of stone forming solutes in urine
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7
Q

Most stones are?

A

Calcium (85%)

- radiopaque

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8
Q

Factors that affect urinary stone formation

A
  • high protein intake
  • high salt intake
  • inadequate hydration
  • Sedentary lifestyle
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9
Q

Stones of our fathers?

A

A clint eastwood movie
- wait, maybe not

They are genetic though

  • calcium based - 50% heritable
  • cystinuria - (autosomal dominant d/o) leads to cysteine stones
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10
Q

Urine pH effects on stones?

A

Acidic

  • uric acid stones
  • cystine stones

Alkaline

  • UTI (urease producing organisms)
  • > struvite stones
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11
Q

5 types of urinary stones?

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Struvite (mg, ammonium phosphate)
  4. Cystine
  5. Uric acid
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12
Q

Staghorn stones are

A

Struvite

- magnesium ammonium phosphate

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13
Q

MC type of stone?

A

Calcium oxalate (by far MC)

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14
Q

Risk factors for calcium oxalate stones?

A

Urinary pH 5.5-6.8

High sodium
High protein
Dehydration
Hypercalciuria
Low urine citrate
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15
Q

Oxalate stones result from?

A

Digestion: oxalate is metabolic end product

Excess ascorbic acid (>2g/day)
- H urinary oxalate levels

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16
Q

Strongest promoter of oxalate stone formation?

A

Urinary oxalate

- it has a high affinity for calcium so calcium follows it into the urine

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17
Q

How does citrate promote calcium phosphate and oxalate stones?

A

Urinary citrate binds w calcium making it unavailable to bind with phosphate and oxalate

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18
Q

PH effect on citrate?

A

Acidosis -> L urinary citrate

Alkalosis -> H urinary citrate

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19
Q

Risk for calcium phosphate stones?

A
  • alkaline urine
  • high sodium
  • high protein
  • dehydration
  • hyepercalciuria
  • low urine citrate

(Pretty similary to calcium oxalate)

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20
Q

MC struvite stone presentation?

A

Women w recurrent UTI w urease-producing baceria

  • proteus
  • pseudomonoas
  • providencia
  • klebsiella
  • staph
  • mycoplama

High urine pH (>7.2)

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21
Q

Struvite stones are made of?

A

Magnesium-ammonium-phosphate stones

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22
Q

Struvite stones on radiograph?

A

Radiopaque

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23
Q

Staghorn calculi?

A

Upper Urinary tract stones that involve:

  • renal pelvis (extend to 2+ calyces)
  • composed of struvite
24
Q

Cystine stones pH?

A

Acidic urine (<5.5)

25
Cystine in urine?
The only amino-acid that is insoluble in urine
26
Risk factors for uric acid stones?
- hyperuricemia - myeloproliferative d/o - malignancy w H uric acid production - abrupt and dramatic wt loss
27
Uric acid urine pH?
Acidic <5.5
28
Uric acid stones radiograph?
Radiolucent
29
Clinical findings for stones? | Obstruction
Obstruction - cholic pain | Hematuria
30
Describe the obstructing stones presentation
- sudden onset (awaken from sleep) - severe, unremitting flank pain - n/v - constant movement of pt
31
Where is the pain with stones?
Initial Episodic - can radiate anterior over abd As progresses down ureter - refers to ipsilateral groin May have CVA tenderness
32
If the stone gets lodged at ureterovesicular junction?
Marked urinary urgency and freq Males get pain at tip of penis
33
Stone size and pain?
Doesnt correlate w symptoms severity
34
Ddx for stones?
``` Bleeding in kidney Pyelonephritis GYN AAA Mesenteric ischemia Herpes zoster Drug-seeking ``` More info on each on slide 25
35
labs for stones?
UA - hematuria - urine pH Serum studies - chem 17 Stone analysis - urine strainer
36
Gold standard of imaging for stones?
Non-contrast CT | - will show all stones radiopaque or radiolucent
37
Other imaging for stones
Plain film (KUB) - gets most stones - cannot r/o stones Renal US - preggo - er use
38
Acute tx for stones?
Asymptomatic and no infection - nothing = 5-6 mm pass spontaneously Hydration is key to stone passing Meds - analgesics - antiemetic - alpha-blocker
39
Indications for referral w stones?
``` Indicated for: – Infection – Obstruction – Intractable pain (admit & control pain) – Persistent nausea/vomiting – Stone size ≥6 mm – Fails to pass w/in 4 weeks – Anatomic abnormalities or single kidney – Patient is pregnant – Patient is immunocompromised – PMH of severe renal disease ```
40
A pt with obstructive urinary calculi w fever and infected urine?
Emergent urologic eval and drainage “Pus under pressure”
41
What is extracorporeal shock wave lithotripsy (ESWL)?
TOC - in 75% requiring tx - works well in renal pelvis - upper 2/3 of ureter - size >1.5cm
42
When using ESWL you need to make sure the pt?
D/c NSAIDS x 3 days prior to lower bleeding risk
43
What may be required following ESWL to facilitate passage of fragmented stones?
Ureteral stent
44
Stones in lower 1/3 of ureter may need?
Ureteroscopic stone extraction
45
Who needs percutaneous nephrolithotomy?
- Stone in renal collecting system - upper 2/3 of ureter - size >2 cm may need?
46
Open stone surgery is reserved for?
Pt w - complex anatomy - obstruction - large infected struvite stones (<5% of cases that need intervention)
47
Bottom line for acute stone tx?
``` Push fluids Pain control Confirm stone Admit (if tx/pain failure) Refer (large, infection, comorbids) ```
48
Recurrent stone formers need?
Lab workup - 24hr urine - serum PTH - Uric acid -> r/o primary hyperparathyroidism or gout
49
With recurrent stone formers you should not restrict?
Calcium - low calcium diets lead to higher risk of stones | - complex process, explained on 43
50
Fiber effect in stones?
Fiber -> H fecal extraction of calcium -> lower urinary calcium
51
Why do soda’s effect stones?
High in phosphate -> H calcium phosphate stones
52
Dont take more than ___ vitamin c if you want to avoid stones?
>2g/day
53
Foods high in oxalate?
Grits and ovaltine | Much much more on slide 45
54
Recurrent stone formers w high/low urinary calcium need? (Med)
High - Thiazide diuretics - HCTZ - chlorthalidone Low - potassium citrate therapy - raise citrate in calcium stone formers - raise pH in uric acid/cystine stone formers
55
Prevent stones w
Water | 1.5-2L/day
56
Follow up for chronic stone formers?
24hr urine q 6 mo Repeate stone analysis if interventions are failing Yearly CT
57
Iguana tap it
But i have reptile dysfunction

Senior - Urology (7 decks)

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