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Renal (CP) > 4 Kidney stones > Flashcards

4 Kidney stones Flashcards

1
Q

What are the common demographics for kidney stones?

A
  • lifetime prevalence in US= 5-15%
  • men > women (2:1)
  • white race more affected
  • peak incidence in middle age
  • substantial regional variations (genetic component)
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2
Q

What causes nephrolithiasis?

A
  • “stone forming diseases”, conditions in which individuals form calculi (stones) within the renal pelvis and tubular lumens
  • drug related disorders
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3
Q

What is nephrocalcinosis? What can cause it?

A
  • Deposition of calcium salts in the renal parenchyma
  • Caused by:
    • “interstitial crystallization“/Randall’s Plaques
    • Medullary Sponge Kidney
    • Crystal (urate) nephropathy
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4
Q

What are bladder stones?

A
  • retention of stone material within the bladder
  • associated with bladder dysfunction
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5
Q

What are the most common type of kidney stones?

A

Calcium stones (oxalate and phosphate) make up 80% of kidney stone cases

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6
Q

Although the exact pathogenesis is unknown, what are 3 key factors behind kidney stones?

A
  • urinary supersaturation (dehydration)
  • crystal retention at the renal papilla
  • associated risk factors (male, family history, diet, etc)
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7
Q

What types of kidney stones are favored at low urine pH?

A
  • uric acid crystals
    • serve as nidus for CaOx crystals
  • cystine crystals (rare)
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8
Q

What types of kidney stones are favored at high urine pH?

A
  • CaPhos
  • Struvite/infectious
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9
Q

What can cause calcium stones?

A
  • hypercalciuria
    • high PTH
    • excessive vitamin D
    • idiopathic
  • hypercalcemia
    • high PTH
    • excessive vitamin D
    • cancer
  • hyperoxaluria
    • excessive vitamin C
    • ethylene glycol (metabolized to oxalate)
    • gastric bypass (Ca binds FAs because of decreased bile, leaving free oxalate to be absorbed)
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10
Q

What are the 4 types of stones we discussed and their prevalence?

A
  • Calcium= 80%
  • Struvite= 15%
  • Uric acid= 5% (but increasing)
  • Cystine= 1%
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11
Q

How would you describe struvite stones? What disorders are they part of?

A
  • Phosphate stones described as “Envelope crystals”
  • Disorders:
    • Staghorn calculi (branched stones that fill all or part of the renal pelvis and branch into several or all of the calyces)
    • Urease positive organisms
    • UTI

**struvite stones like high pH urine!

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12
Q

How would you describe uric acid stones? What disorders are they part of?

A
  • Radiolucent crystals (like low pH)
  • Disorders:
    • metabolic syndrome
    • hyperuricemia/gout
    • increased cell turn over
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13
Q

How would you describe cystine stones? What disorder are they part of?

A
  • hexagonal crystals
  • associated with cystinuria
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14
Q

What are some major risk factors for kidney stones?

A
  • previous renal disease
  • other medical history
    • IBD/short gut
    • hyperparathyroidism
    • hypercalcemia
    • gout
    • HIV (from medications)
  • family history
  • social history
    • dehydration
    • diet
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15
Q

What diet risk factors are associated with kidney stones?

A
  • low fluid intake
  • high salt intake
  • high protein intake (especially meat)
  • low calcium intake
  • high oxalate intake (spinach, beets, rhubarb, nuts, beans, chocolate, soy, tea)
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16
Q

What drugs are associated with causing kidney stones?

A
  • topiramide (for seizures/migraine)
  • ethylene glycol
  • vitamin C
  • indinavir (for HIV)
  • acyclovir (antiviral for herpes)
  • triamterene (K sparing diuretic)
  • sulfamethoxazole (antibiotic)
  • guaifenesin (cough suppressant)
17
Q

What is the cause of cystinuria?

A
  • genetic disorder
  • caused by 2 possible defective genes
    • SLC3A1
    • SLC7A9
  • causes cystine stones (rare)
18
Q

What are some genetic diseases that can cause kidney stones?

A
  • cystinuria (cystine stones)
  • primary hyperoxalosis (CaOx stones)
  • Dent disease (causes CaOx/Phos stones)
  • familial hypomagnesemia with hypercalcemia and nephrocalcinosis (FHHNC)
  • adenosine phosphosribosyltransferase (APRT) deficiency
  • distal renal tubular acidosis
19
Q

How can urinary oxalate levels predict the cause of stones?

A

Slightly high oxalate= enteric or dietary cause

Very high oxalate= genetic/hereditary cause

20
Q

What are some symptoms of kidney stones?

A
  • renal colic (pain, radiation to abdomen/groin)
  • hematuria
  • nausea/vomiting
  • urinary frequency, dysuria
  • fever/chills (elevated WBCs)
  • elevated serum creatinine
21
Q

What imaging can help diagnose kidney stones?

A
  • CT scan (multiple thin slices, no contrast)
  • ultrasound
  • IVP (Intravenous pyelogram)
  • KUB (kidney, urethra, bladder xray)
22
Q

What would you look for in a 24 hr urine study of a patient with possible kidney stones?

A
  • creatinine
  • crystal constituents (Ca, Ox, Phos, uric acid)
  • supersaturation issues (volume, pH, Na)
  • inhibitors (citrate, Mg, K)
23
Q

How do you treat acute kidney stones?

A
  • removal of stones (only if large and won’t pass)
  • symptom (pain) control
  • “Medical expulsive therapy”
    • fluids
    • alpha/Ca blockers and steroids to relax ureter
    • let stones pass on their own
24
Q

What is the chronic treatment for a patient with recurrent uric acid kidney stones?

A
  • dilution (increase fluid intake)
  • low protein/high fruit diet
    • protein=acidic, fruit/veg= alkaline
  • alkalinize urine
  • xanthine oxidase inhibitors (prevent hyperuricemia)
    • allopurinol, febuxostat
25
Q

What is the chronic treatment for a patient with recurrent struvite kidney stones?

A
  • dilution (increase fluid intake)
  • sterilize urine (eliminate urea splitting bacteria)
    • proteus, haemophilus, pseudomonas, klebsiella, staph epidermidis (NOT E coli)
  • remove residual stone material (surgical)
  • adjunctive therapies (urease inh, chemolysis)
26
Q

What is the chronic treatment for a patient with recurrent calcium kidney stones?

A
  • dilution (increase fluid intake)
  • maintain normal calcium intake
  • reduce urine calcium excretion
    • limit Na (salt) and protein in diet
    • thiazide diuretics
  • reduce urin oxalate
  • increase urine citrate (low protein, high fruit diet)

Renal (CP) (16 decks)

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