312 - Nephrolithiasis Flashcards
Which kidney stone do you know? 1\_\_ 2\_\_ 3\_\_ 4\_\_
calcium oxalate (75%) calcium phosphate (15%) uric acid (1%) struvite (<1%)
Which disease are considered as predisposing for nephrolithiasis? 5
GI absorption (Crohn's, gastric bypass) primary hyperparathyroidism obesity DM II distal renal tubular acidosis
Which disease are likely to appear in patients with nephrolithiasis? 5
HTN gout cholecystitis decreased bone density CKD
UTI + nephrolithiasis is an __. It should be treated __ to allow urinary __.
emergency
immediately
flow
Which nutritional risk factors for nephrolithiasis do you know? 4
animal protein
oxalate
sodium
sucrose/fructose
Which protective nutritional factors for nephrolithiasis do you know? 3
calcium
phosphate
phytate
What is the most important crystalizing factor giving rise to kidney stones?
citrate
Vitamin _ supplements may increase the risk for nephrolithiasis.
C
What are the two common presentations of nephrolithiasis?
renal colic
gross hematuria
Renal colic pain does not __. It is __, __ without factors which can __ the pain.
disappear
sudden
unilateral
relieve
Renal colic pain usually accompanies with __ and may __ to different parts such as__ in men and __ in women.
nausea
radiate
testis
labium
What is the treatment for nephrolithiasis + UTI? 2
nephrostomy
stent
Diagnosis is based on __, __ examination, and __ test.
history
physical
urin
Urine test in nephrolithiasis may show __, __, and __.
RBC
WBC
crystals
Confirming nephrolithiasis diagnosis is done with ___without contrast.
Another less sensitive modality is __.
helical CT
US
The go to analgesia is __.
NSAID
Patients with nephrolithiasis should be kept in __ fluid balance.
euvolemic
If pain is sustainable and the patient can drink, treat as __.
outpatient
__ blocker may speed up a spontaneous stone passing.
Alpha
__ intervention should be withheld if possible. Indications include: 4
Urological UTI stone > 6 mm urological abnormalities uncontrolled pain
Stent may increase the risk for __.
UTI
What is the least interventional method to remove kidney stones?
smashing- extracorporeal shockwave lithotripsy
For large urinary stones we use __.
nephrostolithotomy
> 50% of patients with nephrolithiasis will experience __ in the next __ years.
relapse
10
Relapsing nephrolithiasis can be avoided by __.
habitual change
Name two oxalate reach food types:
spinach
potatoes
rhubarb
Which signs may help assessing the risk for nephrolithiasis? 4
overweight
costovertebral angle sensitivity
lower limb edema
systemic disease (hyperparathyroidism/gout)
What should you look at when examining the serum of a patient with suspected nephrolithiasis? 6
electrolytes (hypokalemia, acidosis) Cr calcium uric acid PTH Vitamin D
What should you look at when examining the urine of a patient with suspected nephrolithiasis? 4
WBC
RBC
crystals
culture (if UTI is suspected)
Which urine test is recommended for patients with suspected nephrolithiasis
24 urine collection
24 urine collection examination should include: 6
total volume electrolytes (Ca/Na/K/P( oxalate citrate uric acid pH
If possible, analyzing the __ is necessary.
stone
Performing ___ CT is the gold standard, but should only be done if it will lead to different __ recommendations.
helical
clinical
A good way to decrease the risk for nephrolithiasis is sufficient ___. Urine volume should be > __ liter/day.
hydration
2
Patients with calcium oxalate stones should reduce __ and avoid __ supplement. Using __ will reduce the risk by up to __%.
calcium
vitamin C
thiazide
50
If a patients with calcium oxalate stones is treated with thiazide, remember to restrict __ consumption.
sodium
DASH (__) is recommended for patients with calcium oxalate stones.
dietary approached to stop HTN
Patients with calcium phosphate stones should avoid __. A good treatment is __.
sodium
thiazide
Patients with calcium phosphate stones and low urinary citrate can be treated with __ supplements such as __.
base
potassium citrate
Patients with calcium phosphate stones should keep their urine < __ pH. Remember to keep __ consumption low.
6.5
potassium
Patients with uric acid stones should try and increase their urine’s __. It can be achieved by increasing __, and reducing __.
pH (6-7)
fruits/vegetables (basic)
meat (acidic)
Patients with uric acid stones can increase their urine pH by supplementing __ or - inhibitors (__/__)
citrate salts
Xanthine-oxidase inhibitor
febuxostat/ allopurinol
Struvite stones are the result of __ caused by urease producing bacteria: 3
UTI
Klebsiella pneumoniae
proteus
Providencia
Struvite stones have a typical shape of __. Removal must be done by a __.
staghorn
Struvite stones are __ growing, and can fill the entire __.
fast
kidney
How can you prevent struvite stones?
preventive treatment for UTI
urease inhibitor acetohydroxamic acid
