342 Nephrolithiasis

Question 1

Most common type of kidney stone

Answer 1

Calcium Oxalate (75%)

Question 2

Medullary Sponge Kidney

Answer 2

Often ahve metabolic abnormalities : high urine calcium, lower urine citrate, forms calcium phosphate stones

Question 3

Treatment in UTI in setting of obstructing stone

Answer 3

Drainage
“Urologic emergency”
“pus under pressure”

Question 4

Majority of calcium oxalate stones grown on calcium phosphate at tip of renal papilla called

Answer 4

Randall’s plaque

Question 5

T or F. Higher calcium intake is related to lower risk of stone formation.

Answer 5

T.

Question 6

T or F. Higher intake of animal protein may lead to increased excretion of calcium and uric acid - decreasing risk of stone formation.

Answer 6

F. - increasing risk of stone formation

Question 7

T or F. Higher potassium intake decreases stone formation.

Answer 7

T.

Question 8

T or F. Vitamin C supplements are associated with increased risk of calcium oxalate stone formation.

Answer 8

T. Calcium oxalate stone formers should be advised to avoid Vitamin C supplements.

Question 9

Stone formation increases when urine output is < _ L/day

Answer 9

<1 L /day

Question 10

Coffee, tea, beer and wine are associated with __ risk of stone formation.

Answer 10

decreased

Question 11

Sugar -sweetened carbonated beverage may __ risk.

Answer 11

increase

Question 12

Incidence of stone disease is highest aong

Answer 12

middle age, white men, southeastern of US, weight gain, working in hot environment

Question 13

Urine pH <5.5 -
Urine pH >6.5 -
higher urine pH
Not influenced by urine pH

Answer 13

Uric acid
Calcium oxalate
Cystine
Calcium oxalate

Question 14

Primary hyperoxaluria

Answer 14

Autosomal recessive
Excessive oxalate generation
Stones and renal failureenal failure

Question 15

Cystinuria

Answer 15

Autosomal recessive
abnormal reabsorption of filtered dibasic amino acis
Cystine stones visible on plain radiographs
Staghorn calculi/ bilateral stones

Question 16

Diagnosis is confirmed by appropriate imaging study -

Answer 16

Helical CT - Gold standard

Question 17

Uric acid stones are radioluscent. T or F.

Answer 17

True.

Question 18

Crystals are bipyramidally shaped.

Answer 18

Calcium oxalate dihydrate crystals

Question 19

Hexagonal crystals.

Answer 19

Cystine stones

Question 20

ER management of Nephrolithiasis

Answer 20

NSAIDs
Maintain euvolemia
Use of alpha-blocker - may increase rate of stone passage

Question 21

Doc, mauulit pa po ba ang akin bato sa bato? :(

Answer 21

Yes. More than half of first-time stone formers will have recurrence within 10 years.

Question 22

For all stone types , consistently diluted urine reduces the likelihood of crystal formation.

Doc, gano kadami dapat iihi ko sa isang araw???

Answer 22

Dalawang litro po. Magsimula na po kayo uminom ng tubig ngayon na.

Question 23

Features of Calcium oxalate stones

Answer 23

Higher urine calcium, higher urine oxalate, lower urine citrate

Question 24

Tx for calcium oxalate stones

Answer 24

Diet of 1200mg calcium, low intake of Na<2.5g/day, low animal protien intake, thiazide diuretics, avoiding high dose vitamin C, sucrose and fructose intake

Question 25

___ stones more common in renal tubular acidosis and primary hyperparathyroidism.

Answer 25

Calcium phosphate

Question 26

Management in Uric acid stone formers

Answer 26

alkalinize urine, potassium citrate, vegetables, dec animal flesh, low purine diet, allopurinol, febuxostat

Question 27

Management in cystine stone formers

Answer 27

Tiopronin, penicillamine, tiopronin is preferred, potassium citrate

Question 28

Struvite stones form at pH?

Answer 28

> 8.0

Also known as infection stones or triple phosphate stones