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Nephrology > 312 Nephrolithiasis > Flashcards

312 Nephrolithiasis Flashcards

1
Q 
Which drug is most appropriate to manage colicky pain in nephrolithiasis?
A. Ketorolac
B. Tramadol
C. Morphine
D. Hysocine
A

A. Ketorolac NSAID

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2
Q

Most common type of renal stones

A 
Calcium oxalate 75%
Calcium phosphate 15%
Uric acid 8%
Struvite 1%
Cystine less than 1%
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3
Q

True or false. Radiographic evidence of a second stone should be considered a recurrence even if the stone as not yet caused symptoms

A

True.

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4
Q

Conditions that predispose to stone formation

A 
GI Malabsorption eg in IBD, gastric bypass surgery
Primary Hyperparathyroidism
Obesity
DM type 2
Distal renal tubular acidosis
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5
Q

Point at which concentration product exceed the solubility product

A

Supersaturation

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6
Q

Most clinically important inhibitor of calcium containing stones

A

Urine citrate

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7
Q

Calcium phosphate at the tip of the renal papilla

A

Randall’s plaque

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8
Q

Initiating event in calcium phosphate stone development

A

Tubular plugs of calcium phosphate

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9
Q

Dietary factors that are associated with increased risk of Nephrolithiasis

A 
Animal protein
Oxalate
Sodium
Sucrose
Fructose
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10
Q

Dietary factors associated with lower risk of Nephrolithiasis

A

Calcium
Potassium
Phytate

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11
Q

How does calcium intake lead to decreased risk of Nephrolithiasis

A

Intake of calcium leads to reduction in intestinal absorption of dietary oxalate that results in lower urine oxalate

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12
Q

Strong risk factor for calcium oxalate stone formation

A

Urinary oxalate

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13
Q

Supplement associated with increased risk of calcium stone formation especially among men

A

Vitamin C supplements

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14
Q

Urine output of less than what doubles the risk of stone formation

A

Urine output less than 1L/day

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15
Q

Drinks associated with reduced risk of stone formation

A 
Coffee
Tea
Beer
Wine
Orange juice
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16
Q

Types of stone based on urine pH
Less than 5.5
More then 6.5
No influenced by urine pH

A

Less than 5.5: Uric acid
More then 6.5: calcium phosphate
No influenced by urine pH: calcium oxalate

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17
Q

Autosomal recessive disorder that causes excessive endogenius oxalate generation by the liver with consequent calcium oxalate stone formation and crystal deposition in organs

A

Primary hyperoxaluria

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18
Q

Autosomal recessive disorder that causes abnormal reabsorption of filtered basic amino acids

A

Cystinuria

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19
Q

Two common presentation for individuals with an acute stone event

A

Renal colic

Painless gross hematuria

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20
Q

Mimicker of renal colic. Where is the stone if pain is like acute cholecystitis

A

Right ureteral pelvic junction

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21
Q

Mimicker of renal colic. Where is the stone if us is like acute appendicitis

A

Right pelvic brim

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22
Q

Mimicker of renal colic. Where is the stone if it is like acute diverticulitis

A

Left pelvic brim

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23
Q

Whre is the stone if patient presents with urine urgency and frequency

A

Ureterovesical junction

24
Q

Pain reliever to be given to renal colic that is associated with fewer side effect and effective

A

IV NSAID

25
Q

Drug that when given can increase rate if spontaneous stone passage

A

Alpha blocker

26
Q

True or false. First time stone formers will have recurrence within 10 years

A

True.

27
Q

Cornerstone of which therapeutic recommendation in the management of Nephrolithiasis is based

A

24 hour urine collection

28
Q

Gold standard in the diagnosis of Nephrolithiasis

A

Helical CT without contrast

29
Q

Urine collection sample before committing patient to long term lifestyle changes

A

2 urine collection

30
Q

Target urine volume to reduce stone formation

A

2L/ day

31
Q

Drug that can lower urine calcium excretion

A

Thiazide

32
Q

Foods with high oxalate contents

A

Spinach, rhubarb, almonds and potatoes

33
Q

Natural inhibitor of calcium oxalate and calcium phosphate stones

A

Citrate

34
Q

Type stone more common in patients with distal renal tubular acidosis and primary Hyperparathyroidism

A

Calcium phosphate

35
Q

Two main risk factor of Uric acid stone formation

A

Low urine pH

hight Uric acid excretion

36
Q

Predominant influence on urine acid solubility

A

Urine pH

37
Q

If you have Uric acid stone, what is the target urine pH and how is this achieved?

A

Target urine pH: 6.5

Alkalinize urine with NaHCO3 or Potassium citrate

38
Q

What is the target urine pH for Cystine stones and how is this achieved

A

Target pH: above 7.5

Alkalinize with Potassium citrate or sodium Bicarbonate

39
Q

Treatment for Cystine stone which covalently bind to cystine

A

Tiopronin: preferred

Penicillamine

40
Q

Organism that is associated with Struvite stone

A

Proteus mirabilis
K pneumoniae
Providencia spp

41
Q

Also known as infection or triple phosphate stone

A

Struvite stone

42
Q

What is the usual pH in Struvite stone

A

pH more than 8.0

43
Q

Urease inhibitor drug given to patient with Struvite stone

A

Acetohydroxamic acid

44
Q

True or false. Increased dietary calcium is predisposed to kidney stone

A

False. Low calcium

45
Q

Single most strong predictor of nephrolithiasis

A

Hematuria

46
Q

Pain control on nephrolithiasis

A

Ketorolac + meperidine/ morphine

47
Q

Size of stone warranting urologic evaluation

A

Stone more than 10 mm (ESWL or endoscopic)

Urosepsis for emergent decompression (ureteral sent or nephrostomy tube)

48
Q

What to with stone less than 10 mm

A

Medical management

49
Q

Rate of spontaneous passage is determined by size and location of stone

A 
87% = 1 mm
76%= 2-3 mm

78%= UVJ stone

50
Q

How to facilitate stone passage

A

Alpha blockers

Less effective for 5 mm size

51
Q

Examples of medical expulsive therapy

A

Alpha blocker: tamsulosin in 5-10 mm diameter

Ca channel: Nifedipine

52
Q

How to prevent calcium stones

A

Hydrochlorothiazide

K citrate/ NaHCO3

53
Q

What causes hyperoxaluria

A

High dose Supplemental vitamin C
Post bariatric surgery
High oxalate diet

54
Q

How to deal with hyperoxaluria

A

Ca Carbonate or citrate 1-4 g/dl

Potassium alkali to correct acidosis

55
Q

True or false. Cautious alkali supplementation in calcium phosphate stone

A

True.

Nephrology (6 decks)

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