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Urology > 1.17 + 18 urolithiasis > Flashcards

1.17 + 18 urolithiasis Flashcards

1
Q

Epidemiology of urolithiasis?
gender
recurrent rate
age

A
  • 5% will have a stone related event in the developed world
  • Incidence increases
  • Male-female ratio: 3:1
  • Most frequent between 20-50 years
  • The recurrence rate is 50% in 10 years
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2
Q

Etiology of urolithiasis?

A

Lifestyle
Endogenic factors

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3
Q

what are the risk factors in life style perdisposing urolithiasis?

A
  • Lack of physical activity
  • Western unhealthy diet which is high in:
    (salt
    protein
    fat
    carbohydrates)
  • Insufficient fluid intake!
  • Insufficient fiber intake
  • Iatrogenic:
    (Vitamin C& D, other drugs)
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4
Q

give examples about Endogenic factors perdisposing urolithiasis?

A

Hypercalciuria
Hyperoxaluria
- Idiopathic hypercalciuria
- Cystinuria
- Primary hyperoxaluria
- increased urine pH
- decreased urine volume
- male gender
- Hyperparathyroidism
- Familial renal tubular acidosis

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5
Q

name the Theories of stone formation?

A

Nucleation theory
organic matrix theory
crystallization inhibition theory

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6
Q

briefly explain Nucleation theory..

A

Urine is supersaturated, and

the presence of crystal or foreign body
initiates stone formation

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7
Q

briefly explain Organic matrix theory…

A

An organic matrix of serum and urinary proteins (albumins, globulins, mucoproteins)

provides a framework for deposition of crystals.

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8
Q

briefly explain Inhibitor of crystallization theory…

A

Absence of inhibitors (Mg, citrate, mucoproteins) permits crystallization.

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9
Q

do you know about any additional factors that might be found influencing the pathological development of urolithiasis?

A

It is more likely that more than one factor operates in causing stone disease.
Additional risk factors include:
- anatomical abnormalities
- infectios

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10
Q

Process of stone formation?

A
  1. Supersaturation of the content of stone in the urine
  2. Crystallization – homogenous or heterogenous (blood clot, damaged renal papilla, foreign body)
  3. Stone retention
  4. Phase of growing
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11
Q

what’s the Stone composition of?

A

Calcium oxalate - monohydrate
Calcium oxalate - dihydrate
Calcium phosphate
Uric acid
Cystine
Infected stones (struvite)- ammonium, Mg, phosphate

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12
Q

what’s the pH of Calcium oxalate - monohydrate?

A

5,5-6,4

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13
Q

what’s the pH of Calcium oxalate - dihydrate?

A

5,5-6,5

same as monohydrate

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14
Q

what’s the pH of Calcium phosphate?

A

6,5-7,5

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15
Q

what’s the pH of Uric acid?

A

4,5-5,5

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16
Q

what’s the pH of Cystine?

A

5,5-7,0

17
Q

what’s the pH of Infected stones (struvite)

A

6,5-8,5

18
Q

describe briefly the features of Calcium oxalate - monohydrate stone…

A

Dark brown
smooth
hard (thats what she said)
less than 1cm
radiopaque

19
Q

describe briefly the features of Calcium oxalate - dihydrate stone…

A

light brown
speculated
fragile
radiopaque
>2cm

20
Q

describe briefly the features of Calcium phosphate stone..

A

White light brown
speculated
hard (thats what she said)
very radiopaque

21
Q

which is more common calcium oxalate stones or Ca-P in general?

A
  • Ca-oxalate More common than calcium phosphate
22
Q

calcium phosphate stones?
Therapy

A

th:
-low-sodium diet
-thiazides

23
Q

describe briefly the features of Uric acid stone..

A

Yellow-brown
Rhomboid or rosettes
smooth
hard (as she said)
radiolucent (the only one that’s radiolucent)

24
Q

Uric acid stones
-Risk factors
-therapy

A

risk factors:
–>decrease urine volume
–>decrease urine pH

  • Strong association with hyperuricemia (eg. gout)
    -often coexist with diseases in which there is high cell
    turnover (eg. leukemia)
  • th:
    –> alkalization of urine
    –>allopurinol
25
Q

describe briefly the features of Cystine stone..

A

Yellow to brown
Hexagonal
smooth
hard (ts’she said)
Faintly radiopaque

26
Q

Cystine stone
Etiology
Therapy

A
  • Hereditary (AR)
  • cystine reabsorbing-PCT-transporter loses function resulting in:
    1. cystinuria (is poorly soluble) –> stones form in urine
    2. poor reabsorption of:
    ->irnithine
    ->lysine
    ->arginien (COLA)
  • Usually begins in childhood
  • Can form staghorn calculi
  • Positive sodium cyanide nitroprusside test

-th:
->low Na diet
->alkalinization of urine
->chelating agents (eg. penicillamine) if refractory

27
Q

describe briefly the features of Ammonium
magnesium phosphate (sturvite) Infected stone

A

Smooth
Coffin lid
soft
lightly colored
rapidly growing into staghorn calculi
slightly radiopaque

28
Q

Ammonium magnesium phosphate (sturvite) infected stones
caused by
therapy

A
  • Caused by infection with urease +’s:
    –> P.mirabilis
    –> S. saprophyticus
    –> Klebsiella that hydrolyze urea->amonia-> urine alkalinization
  • Commonly form staghorn calculi
  • th:
    –>eradication of underlying infection
    –>surgical removal of stone
29
Q

what are the symptoms of urolithiasis?

A

Asymptomatic (when stone in renal collecting system)
ureteric stones –>obstruction which leads to:
->colic pain (localized to the tip of the penis)
->hydronephrosis pain
-> Hematuria
->AKI (obstructive)
->nfection -> obstructive pyelonephritis

30
Q

how do you diagnose urolithiasis?

A
  • US:
    ->mainly for renal stones
    ->stones appear echogenic with shadows behind
  • plain Xray
  • IV pyelography, retrograde pyrography
    ->stones creates filling defect

-Low-dose CT (gold-std) info about:
-> size
->location
->HU value >1000 is considered hard stone
->HU <800 is considered soft stone which is more susceptible to ESWL treatment (Extracorporeal shock wave lithotripsy)

-Consider renal function tests (BUN/Cr)

31
Q

how do you treat urolithiasis?

A

Conservative approach
Extracorporeal shock wave lithotripsy (ESWL)
Percutaneous nephrolithotomy:
Retrograde uretero-renoscopy
Open surgery
Management of obstructive pyelonephritis

32
Q

what is the Conservative approach in the treatment of urolithiasis

A

consider if patient is mildly symptomatic and stone is small:
- Pain control (NSAIDs, opioids)
- Spasmolytics (drotaverine)
- Phytotherapy (induces ureter peristalsis)
- beta-blockers (if small stone in the lower part of the ureter)

33
Q

what is the (ESWL) in the treatment of urolithiasis?

A
  • xtracorporeal shock wave lithotripsy
  • US shock wave creates pressure differences between surface and core of the stone –> stone is crashed into smaller fragments
  • Effective for treating kidney stones <2 cm in diameter, as long as no obstruction to the passage of stone fragments is present.
34
Q

what is Percutaneous nephrolithotomy in the treatment of urolithiasis?

A
  • for Stones >2 cm in diameter
  • Under fluoroscopic control, a track with a diameter of ~1cm is introduced into the collecting system
  • Disintegrating devices (US-based), which can be introduced through a nephroscope, are used
    to break the stone into fragments that can be evacuated
35
Q

what is Retrograde uretero-renoscopy procedure in the treatment of urolithiasis?

A
  • Laser fiber is introduced through a flexible guide wire, which is introduced through the urethra and bladder, up the ureter to the renal collecting system
  • Stones < 1 cm in diameter can be disintegrated
  • Use a Dormia basket or forceps to collect stone fragments
36
Q

describe the Open surgery in the treatment of urolithiasis..

A
  • Not frequently indicated
  • Staghorn stones, in which the bulk of the stone lies within calices rather than within the renal pelvis, are treated best by open surgery.
  • Kidneys that contribute < 10% of overall renal
    function should usually be removed
37
Q

describe the Management of obstructive pyelonephritis in the treatment of urolithiasis…

A

->Antibiotics
->antipyretics
->fluids
-> Urine deviation (nephrostomy or Double-J stent)
-> Stone removal

38
Q

how do you prevent urolithiasis?

A

-Up to 50% of patients who produce their first stone will have a recurrence within 10 years.

  • we Consider analysis of stone composition
  • determine further metabolic changes that can have beneficial effect on reducing the risk of stone reoccurrence:
    ->increase fluid intake (aim for >2L/day urine output)
    ->Thiazide diuretics (for idiopathic hypercalciuria)
    -> decrease uric acid lvls (lifestyle changes, allopurinol)
    -> AB to eradicate any urinary tract infection
    -> Low-sodium diet, low-protein diet, low-purine diet
39
Q

Ca-oxalate stones Can result from

A

–> ethylene glycol (antifreeze) ingestion
–> VitC abuse
–> hypocitraturia associated with decreased urine ph (eg. Crohn disease)

Urology (30 decks)

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