AUA-2014 (Rechecked 2019) - Medical Management of Kidney Stones: AUA Guideline

Question 1

Is the use of fast and calcium load test recommended for distinguishing among the types of hypercalciuria?

Answer 1

No

Question 2

If someone has recurrent calcium based stones and a normal work up but keeps forming stones what is recommended?

Answer 2

Thaizide diuretics and/or potassium citrate

Question 3

Is allopurinol recommended as first line therapy for treatment of uric acid stones?

Answer 3

NO, it is primarily a disease of urine volume and pH.

Question 4

What percentage of first time stone former will experience a second episode?

Answer 4

50%

Question 5

what is the prevalence of stone disease?

Answer 5

8.8% or 1 in 11

Question 6

what did nurses health study and health professionals follow up study identify as risk for first time stone formation?

Answer 6

• low calcium intake
• low fluid intake
• sugar sweetened beverages
• animal protein
• men with a BMI>25

Question 7

Name stone provoking medications or supplements

Answer 7

Probenecid
some protease inhibitors 
lipase inhibitors 
triamterene 
chemotherapy 
vitC
vitD
calcium
carbonic anhydrase inhibitors such as topiramate, acetazolomide, zonisamide

Question 8

High VitD level can mask primary hyperparathyroidism

Answer 8

WRONG

low vitD can mask it.

Question 9

List diffrential Dx for nephrocalcinosis

Answer 9

RTA type 1
primary High PTH
medullary sponge kidney
primary hyperoxaluria

Question 10

When should primary hyperoxaluria be suspected on 24 hour urine?

Answer 10

Oxalate urine > 75 mg/day
in the absence of bowel dysfunction
refer these patietns to genetic testing.

Question 11

Should stone formers reduce sweetened beverages?

Answer 11

yes, studies show sweetened beverages increase risk. sodas partiuclarly ones with phosphproic acid seem to be worse.

Question 12

what should be recommended to a patient with calcium stones and high urinary calcium

Answer 12

limit Na intake(<2300 mg/day)

1000-1200 mg calcium per day of dietary ca

Question 13

What is DASH diet?

Does it help with stones?

Answer 13

diet high in fruits and vegetables, moderate in low fat dairy products, low in animal protein
yes, reduced risk of kidney stones

Question 14

list 4 causes of hypocitraturia

Answer 14

chronic diarrhea states
Carbonic anhydrase inhibitors
RTA
Any acidodic state

Question 15

Does dietary citrate directly get excreted in urine?

Answer 15

No, It is converted to bicarb in vivo and the alkali load increases citrate excretion. only a small amount makes it to urine

Question 16

which caox stone former should get allopurinol

Answer 16

recurrent cox stone former with normal urinary calcium and elevated urinary uric acid

Question 17

Can you offer thiazide diuretics or K-citrate to recurrent calcium stones who had a negative work up but keep making stones

Answer 17

Yes

Question 18

what is the urinary ph goal for treatment of uric acid stones as per AUA? and what is it for cystine?

Answer 18

6
7
both as per AUA. CUA says 7-7.5 for cystine

Question 19

What is first line therapy for cystine stone formers?

Answer 19

Increased fluid intake
alkalinize urine
restrict na
limit protein intake

Question 20

What are two side effects of acetohydroxamic acid?

Answer 20

Phlebitis

hypercoaguable phenomenon

Question 21

When should you follow up after initiation of medical therapy with repeat 24 hour urine?

Answer 21

6 months
and then annually thereafter
and then dc as you deem appropriate