Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr3 Met 3B > 13. Urinary Calculus Disease > Flashcards

13. Urinary Calculus Disease Flashcards

1
Q

What different types of stones exist in the context of Urinary Calculus Diseases?

A
  1. Calcium Oxalate
  2. Urate
  3. Magnesium Ammonium Phosphate
  4. Cysteine
  5. Xanthine, Idinavir, Matrix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is generally the most common composition of kidney stones?

A

80% CaOX

20% CaPO4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the main properties of the Calcium Oxalate stone?

A
  1. Most common type of stone
  2. Insoluble
  3. Shows up on X-rays
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What conditions are associated with the Calcium phosphate stone?

A
  1. Hyperparathyroidism
  2. Distal Renal Tubular Acidosis (Type 1)
  3. Medullary Sponge Kidney (MSK)
  4. Urinary Stasis and infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What diseases can Urate crystals associate with?

A
  1. Metabolic Syndrome

2. Gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which stones can be seen well on X-rays?

A
  1. Calcium Oxalate
  2. Calcium Phosphate (reasonably well)
  3. Magnesium Ammonium Phosphate (slightly)
  4. Cysteine (POOR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How hard is Magnesium Ammonium Phosphate stones?

A

200-600 HU (soft)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are Magnesium ammonium phosphate crystals usually called?

A

Struvite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which stones are associated with Staghorn Calculi?

A

Magnesium Ammonium Phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which stones are associated with metabolic syndrome?

A

Urate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which stones are associated with cysteinuria

A

Cysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What stones make white smomke and a rotten egg smell during lasering?

A

Cysteine (H2S)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of stone used to show up poorly on CT and was initially used for HIV?

A

Idinavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the Two Factors influencing Stone formation?

A

Free

Fixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the Free Theory influencing Stone Formation?

A

Presence of Stone Constituents in appropriate amounts (without inhibitors) WILL form stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the Fixed Theory influencing Stone Formation?

A

Energy needed to make a crystal (Lattice Enthalpy of Formation) is Lower if there is a surface to form them on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Free Theory affected by?

A
  1. Solute Concentration
  2. Urine Acidity
  3. Formation Inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the Fixed Theory affected by?

A
  1. Surface the lattice forms on
  2. The Crystals
  3. Randall’s Plaques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do Calcium Oxalate stones form?

A
  1. Randall’s Plaques
    - CaPhos forming in the kidney interstitium
    - Urothelium ulcerates and exposes plaque to urinary surface
  2. Duct of Bellini Plugs
    - Stones form in the tubes and get stuck on the papillary surface
20
Q

How do we get excessive Calcium in our systems?

A

Hypercalcemia

  • Hyperparathyroidism
  • Sarcoidosis
  • Excess Vitamin D
21
Q

How do we get excessive Oxalate in our systems?

A
  1. Diet
  2. Endogenous sources from liver (Glycolate metabolism)
  3. Vitamin C conversion too
22
Q

How does Calcium oxalate form?

A

Calcium binds to oxalate in the gut and stops it from being absorbed

23
Q

What can cause Enteric Hyperoxaluria?

A

Malabsorption

  • Colitis (Crohn’s)
  • Jejunoileal Bypass surgery
24
Q

What foods have High levels of unopposed oxalate

A
  1. Beetroot
  2. Spinach
  3. Rhubarb
25
Q

What is THP?

A

Tamm Horsfall Protein/Uromodulin

26
Q

What does THP do?

A

Inhibits stone formation

27
Q

How does THP work?

A

Prevents stones from binding to renal epithelial cells and reduces free calcium on the crystal for growth

28
Q

Mutations on THP can often lead to what?

A
  1. Familial Juvenile Hyperuremic Nephropathy

2. Medullary Cystic Kidney Disease 2

29
Q

A man presents with sudden onset of

  • Severe RHS Loin Pain + Tenderness
  • Pain radiates to Groin
  • Writhing in Agony
  • Apyrexia
  • Blood ++ on Urine
  • FBC Normal
  • Elevated Creatinine

What is the likely cause of pain?

A

Ureteric Colic: Comes and goes with background of pain

Differentials

  1. Bowel Colic comes and goes completely between bouts
  2. Leaking AAA must be considered in older
  3. Biliary Colic: Right Upper Quadrant
  4. Ectopic Pregnancy
  5. Pneumonia/Pancreatitis/MI
  6. Pyelonephritis
  7. Bleeding Tumours (Renal Cell Carcinoma)
30
Q

For Ureteric Colic, you must be mindful of Infection. What tests should be done?

A
  1. Urine Dip
    - Leukocytes/Nitrates/Urine pH
  2. MSU
  3. Blood Tests
    - FBC
    - U+E (Creatinine, but beware of a stone in a solitary kidney)
    - Calcium and Urate
31
Q

What is the mainstay of Imaging stones in kidneys?

A

Ultra Low Dose CTKUB

- 99% diagnosed

32
Q

What alternatives are there for Kidney imaging

A
  1. Ultrasound
    - Non-irradiating
    - Best for Pregnancy and children
33
Q

What is the Sensitivity and Specificity of CTKUB?

A

50%

- Urate stones tend to be lucent

34
Q

What is the sensitivity of US for kidney stones?

A

75%

- Can miss big and small ones

35
Q

What treatment can be provided for Kidney Stones?

A
  1. Analgesia
  2. Hydration
  3. Medical Expulsive Therapy
  4. Removal of stone
36
Q

What can be provided Analgesia-wise for kidney stones?

A

NSAIDs

Opiates

37
Q

How can hydration be provided for kidney stones?

A

IV if necessary especially if they are vomiting

38
Q

How is Medical Expulsive Therapy performed for kidney stones?

A

Tamsulosin relaxes the lower ureter and increases the stone passage

39
Q

Why can’t we use Medical Expulsive Therapy for the Upper Ureter?

A

Few alpha receptors are here

40
Q

When indications can Metabolic Testing be used for Kidney stones?

A
  1. Multiple stone attacks
  2. Bilateral stone disease
  3. Solitary kidney
  4. Urate/Cysteine/Calcium stones
41
Q

What does Metabolic Testing involve?

A
  1. 2 x 24 hour urine collections: Calcium/Oxalate/Urate/Volume/Sodium and Citrate
  2. Spot Nitroprusside test for Cysteine
  3. Blood tests: Calcium, Urate, Bicarb, U&Es
42
Q

What is the best way of preventing Kidney stones?

A
  1. Increase Urine Flow >2L per day
  2. Reduce Sodium and Increase Potassium (Citrus)
  3. Low oxalate
  4. Low fats
  5. High protein
43
Q

What are the best drug therapies for kidney stone prevention and why?

A
  1. Thiazides (Reduces Calcuria)
  2. Potassium Citrate (Poor toleration)
  3. Sodium Bicarbonate
  4. Allopurinol
  5. Penicillamine and Thiola (Cysteinuria)
44
Q

How can we monitor the treatment of Kidney stones?

A
  1. 24 Hour Urine
    - Urine volume and Na intake
  2. Spot urine for Na/K as an alternative
  3. Blood urate in Allopurinol users
  4. Help from an endocrinologist in Metabolic Syndrome
45
Q

When is the next follow up expected for an individual with Kidney stones?

A
  1. 50% chance of another stone in 10 years if there is no change in diet
  2. Increasing Fluid Intake will reduce risk by 40%
  3. 6-12 month KUB is good

Yr3 Met 3B (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions