103114 kidney stones

Question 1

nephrocalcinosis

Answer 1

crystal components in body of pelvis as opposed to renal pelvis outside the kidney

Question 2

3/4 of kidney stone incidences derive from what composition

Answer 2

calcium oxalate

Question 3

struvite

Answer 3

magnesium ammonium phosphate

Question 4

struvite crystals caused by?

Answer 4

urea splitting bacteria in urine

Question 5

ex of nephrocalcinosis

Answer 5

medullary sponge kidney
instersitial crystallization/Randall’s plaque
crystal nephropathy (ex-urate nephropathy)

Question 6

nephrolithiasis/urolithiasis

Answer 6

kidney stone

Question 7

metabolic origins of crystals in stones

Answer 7

calcium oxalate
calcium phosphate
urates
struvite
cysteine (genetic abnormality)

Question 8

primary hyperoxalosis

Answer 8

rare genetic disorder of liver enzyme leading to excessive endogenous oxalate synthesis

in general, genetic disorders only account for a small percentage of all stone formations

Question 9

is supersaturation of CaOx enough to cause stone disease?

Answer 9

no

Question 10

high or low calcium intake is a risk factor for kidney stone?

Answer 10

low calcium intake

Question 11

tx for acute kidney stone disease

Answer 11

removal of stone (if big):
extracorporeal shock wave litotripsy
ureteroscopy
percutaneous approach

symptom control (pain)

noninvasive: pain control and fluids, medical expulsive therapy (alpha blockers, steroids, Ca blockers, dissolution therapy for uric acid)

Question 12

tx for chronic kidney stone disease (prevention)

Answer 12

metabolic evaluation to look at urine chemistry

medications

Question 13

chronic tx for cystine stones

Answer 13

dilution
alkalinize urine
cystine binding drugs

Question 14

chronic tx for uric acid stones

Answer 14

dilution
low protein and high fruit diet
alkalinize urine
xanthine oxidase inhibitors

Question 15

struvite stones chronic tx

Answer 15

dilution
sterilize urine
remove residual stone material (b/c hard to sterilize)

Question 16

calcium stones chronic tx

Answer 16

dilution
maintian normal Ca intake
reduce urine calcium excretion (limit Na and protein in diet, add thiazide diuretics)
reduce urine oxalate (add Ca or limit diet oxalate)
increase urine citrate