342 Nephrolithiasis Flashcards
Most common type of kidney stone
Calcium Oxalate (75%)
Medullary Sponge Kidney
Often ahve metabolic abnormalities : high urine calcium, lower urine citrate, forms calcium phosphate stones
Treatment in UTI in setting of obstructing stone
Drainage
“Urologic emergency”
“pus under pressure”
Majority of calcium oxalate stones grown on calcium phosphate at tip of renal papilla called
Randall’s plaque
T or F. Higher calcium intake is related to lower risk of stone formation.
T.
T or F. Higher intake of animal protein may lead to increased excretion of calcium and uric acid - decreasing risk of stone formation.
F. - increasing risk of stone formation
T or F. Higher potassium intake decreases stone formation.
T.
T or F. Vitamin C supplements are associated with increased risk of calcium oxalate stone formation.
T. Calcium oxalate stone formers should be advised to avoid Vitamin C supplements.
Stone formation increases when urine output is < _ L/day
<1 L /day
Coffee, tea, beer and wine are associated with __ risk of stone formation.
decreased
Sugar -sweetened carbonated beverage may __ risk.
increase
Incidence of stone disease is highest aong
middle age, white men, southeastern of US, weight gain, working in hot environment
Urine pH <5.5 -
Urine pH >6.5 -
higher urine pH
Not influenced by urine pH
Uric acid
Calcium oxalate
Cystine
Calcium oxalate
Primary hyperoxaluria
Autosomal recessive
Excessive oxalate generation
Stones and renal failureenal failure
Cystinuria
Autosomal recessive
abnormal reabsorption of filtered dibasic amino acis
Cystine stones visible on plain radiographs
Staghorn calculi/ bilateral stones
Diagnosis is confirmed by appropriate imaging study -
Helical CT - Gold standard
Uric acid stones are radioluscent. T or F.
True.
Crystals are bipyramidally shaped.
Calcium oxalate dihydrate crystals
Hexagonal crystals.
Cystine stones
ER management of Nephrolithiasis
NSAIDs
Maintain euvolemia
Use of alpha-blocker - may increase rate of stone passage
Doc, mauulit pa po ba ang akin bato sa bato? :(
Yes. More than half of first-time stone formers will have recurrence within 10 years.
For all stone types , consistently diluted urine reduces the likelihood of crystal formation.
Doc, gano kadami dapat iihi ko sa isang araw???
Dalawang litro po. Magsimula na po kayo uminom ng tubig ngayon na.
Features of Calcium oxalate stones
Higher urine calcium, higher urine oxalate, lower urine citrate
Tx for calcium oxalate stones
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
___ stones more common in renal tubular acidosis and primary hyperparathyroidism.
Calcium phosphate
Management in Uric acid stone formers
alkalinize urine, potassium citrate, vegetables, dec animal flesh, low purine diet, allopurinol, febuxostat
Management in cystine stone formers
Tiopronin, penicillamine, tiopronin is preferred, potassium citrate
Struvite stones form at pH?
> 8.0
Also known as infection stones or triple phosphate stones
