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Renal > 16 - Obstruction and Stones > Flashcards

16 - Obstruction and Stones Flashcards

1
Q

MCC AKI

A

ATN

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2
Q

signs of UTO

A 
dec urine output
flank pain
renal colic / hematuria if stone
hesitancy
dribbling
frequency, nocturia
recurrent UTIs (esp in men)
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3
Q

2 settings in which you can have obstruction w/ no dilation of kidneys

A

hypovolemia

retroperitoneal fibrosis

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4
Q

2 cases of physiologic hydronephrosis

A

pregnancy

renal allograft

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5
Q

MCC UTO in children, adults, women

A

children - congenital
adults - BPH/stones
women - mass/malignancy until proven otherwise

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6
Q

triphasic pattern of UTO

A

1 - GFR declines b/c inc pressure in tubules, RBF inc to counterbalance to preserve GFR (NO, PGE)
2 - for 3-4 hrs, pressure remains elevated but RBF begins to decline (ATII, TXA2, endothelin)
3 - 5 hrs after, further decline in RBF. Dec in tubular pressure - stabilization

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7
Q

tx of kidney stone

A

hydration, ureteral dilators (flomax), urologic intervention if necessary

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8
Q

long term consequences of UTO

A

changes in collecting duct function > dec responsiveness to ADH > mimics DI
renal tubular acidosis, inability for kidneys to acidify urine

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9
Q

MC types of stones (top 4)

A

calcium oxalate
struvite
calcium phosphate
uric acid

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10
Q

struvite stones are assoc w/

A

infection (urease producing bugs)

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11
Q

uric acid stones

A

potentiate Ca stone formation
consider high cell turnover conditions (leukemia, myeloprolif, etc)
radiolucent

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12
Q

cystinuria

A

AR disorder
cant reabs cystine, ornithine, arginine
hexagonal crystals

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13
Q

common cause of drug kidney stones

A

HAART

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14
Q

upper limit of metastability (ULM)

A

super saturation point needed to induce crystallization of stones

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15
Q

Randall’s plaques

A

hydroxyapatite formation in renal papillae, nidus for crystallization
BM of thin limbs becomes template to begin crystallization

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16
Q

2 most important crystallization inhibitors

A

magnesium (binds oxalate) and citrate (complexes w/ Ca but stays soluble)

17
Q

2ndary hypercalciuria can be due to

A 
sarcoidosis, TB, granulomatous dzs
malignancy
paget's dz
immobilization
hyperPTH, hyperthyroid, Cushing's
loop diuretics
vit D supplements
RTA
medullary sponge kidney
18
Q

2 most common sites for kidney stone presentation

A 
ureverovesical junction (60%)
proximal ureter (23%)
19
Q

management of acute stone

A

rule out renal failure and sepsis
pain relief, IV fluids, +/- alpha blocker, ureteroscopy
detailed workup if multiple stone history, family history, or renal failure

20
Q

when is extracorporeal shock was lithotripsy effective?

A

stones <1cm, esp distal

21
Q

kidney stone prevention

A 
drink lots of water
low sodium
high K intake may help, as may less animal protein
STOP vitamin C supplements
more magnesium
allopurinol for uric acid stones

Renal (20 decks)

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