Calcium, Mag, Phos, Stones Flashcards
Most stones are made of this element
calcium, usually Ca Ox (80%)
Ca Phos (hydroxyapatite) 20%
- consider primary HPT, distal RTA (high Ur pH)
More common stone to see in DM
uric acid, 60% in DM, overall 10-15%
Type of stone with UTI
struvite, 5-10%
More common stone in children
cystine, only 1% in adults
Name risk factors for calcium stone formation
Associate the following Ur pH with dx/type of stone:
high urine pH 6.5-7
very high pH 8-9
low pH 5-5.5
high: RTA
very high: struvite stones
low: uric acid
Name some medications associated with stones
Ideal urine volume target in stone prevention?
> /= 2L, supported by RCT
*coffee/beer are protective!
Increase dairy intake
800-1200mg Ca/day
PharmTx: thiazides, can even use in normal Ur Ca (chlorthalidone and indapamide
- supplement K-citrate
- other: amiloride/spiro
C
A: citrate can lower Ur Ca, no difference is shown between meds though
B: technically true, but isn’t a contributory issue overall
D: doesn’t happen, only with urease-producing organisms
Describe distal RTA:
Ur pH
K
type of stone
citrate
Ur Calcium
Treatment?
This surgery is associated with hyperoxaluria
Roux-en-Y
not as much in gastric sleeve
Name 3 contributors to uric acid stones
Treatment of uric acid stones
What bugs are associated with struvite stones?
What is struvite made of?
Cystinuria
- impaired PCT reabsorption
Management of cystinuria
Dent disease is associated with this kidney pathology/disease?
Medullary nephrocalcinosis
Dent 1 CLCN5 gene or Dent 2 OCRL1
- high Ur Ca, inc activation of 1,25
- LMWP (B2MG and retinol-binding/FSGS) and/or albuminuria
Primary Hyperoxaluria
- dx young but can be missed
DHA stone d/t defect in APRT enzyme (adenine metabolism to AMP)
- accumulation of 2,8 DHA via xanthine oxidate
Phosphorus transporters
