13. Urinary Calculus Disease Flashcards
What different types of stones exist in the context of Urinary Calculus Diseases?
- Calcium Oxalate
- Urate
- Magnesium Ammonium Phosphate
- Cysteine
- Xanthine, Idinavir, Matrix
What is generally the most common composition of kidney stones?
80% CaOX
20% CaPO4
What are the main properties of the Calcium Oxalate stone?
- Most common type of stone
- Insoluble
- Shows up on X-rays
What conditions are associated with the Calcium phosphate stone?
- Hyperparathyroidism
- Distal Renal Tubular Acidosis (Type 1)
- Medullary Sponge Kidney (MSK)
- Urinary Stasis and infection
What diseases can Urate crystals associate with?
- Metabolic Syndrome
2. Gout
Which stones can be seen well on X-rays?
- Calcium Oxalate
- Calcium Phosphate (reasonably well)
- Magnesium Ammonium Phosphate (slightly)
- Cysteine (POOR)
How hard is Magnesium Ammonium Phosphate stones?
200-600 HU (soft)
What are Magnesium ammonium phosphate crystals usually called?
Struvite
Which stones are associated with Staghorn Calculi?
Magnesium Ammonium Phosphate
Which stones are associated with metabolic syndrome?
Urate
Which stones are associated with cysteinuria
Cysteine
What stones make white smomke and a rotten egg smell during lasering?
Cysteine (H2S)
What type of stone used to show up poorly on CT and was initially used for HIV?
Idinavir
What are the Two Factors influencing Stone formation?
Free
Fixed
What is the Free Theory influencing Stone Formation?
Presence of Stone Constituents in appropriate amounts (without inhibitors) WILL form stones
What is the Fixed Theory influencing Stone Formation?
Energy needed to make a crystal (Lattice Enthalpy of Formation) is Lower if there is a surface to form them on
What is the Free Theory affected by?
- Solute Concentration
- Urine Acidity
- Formation Inhibitors
What is the Fixed Theory affected by?
- Surface the lattice forms on
- The Crystals
- Randall’s Plaques
How do Calcium Oxalate stones form?
- Randall’s Plaques
- CaPhos forming in the kidney interstitium
- Urothelium ulcerates and exposes plaque to urinary surface - Duct of Bellini Plugs
- Stones form in the tubes and get stuck on the papillary surface
How do we get excessive Calcium in our systems?
Hypercalcemia
- Hyperparathyroidism
- Sarcoidosis
- Excess Vitamin D
How do we get excessive Oxalate in our systems?
- Diet
- Endogenous sources from liver (Glycolate metabolism)
- Vitamin C conversion too
How does Calcium oxalate form?
Calcium binds to oxalate in the gut and stops it from being absorbed
What can cause Enteric Hyperoxaluria?
Malabsorption
- Colitis (Crohn’s)
- Jejunoileal Bypass surgery
What foods have High levels of unopposed oxalate
- Beetroot
- Spinach
- Rhubarb