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6- Renal Medicine > Calculus Dx > Flashcards

Calculus Dx Flashcards

1
Q

Risks factors of calculus

A

Increased weight and body mass index
Increased socioeconomic status
Obesity in women
Metabolic syndrome (acid calculi due to low urinary pH)

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2
Q

2 phenomenon important for crystal formation in urine

A

Supersaturation of urine with stones

Presence of urinary inhibitors - nephrocalcin, uropontin, citrate, magnesium , tamm-horsfall

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3
Q

What is the noncrystalline component of stones made of

A

Mucoprotein s
Proteins
Carbohydrates
Urinary inhibitors

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4
Q

Most important determinant of acid stone formation

A

Low urinary pH

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5
Q

Stones formed in low pH

A

Calcium oxalate stones
Uric acid stones

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6
Q

Type of urine in infection stones

A

Alkaline urine

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7
Q

Type of bacteria in infection stone

A

Urease producing bacteria

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8
Q

Name of stones formed in infection stones

A

Triple phosphate stones

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9
Q

What happens when urine is above Ksp (solubility product )

A

Normally no formation of crystals due to inhibitors of crystal formation

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10
Q

What happens when urine concentration of calcium and oxalate is very high above Kf ( formation product)

A

Inhibitors become ineffective and crystals form

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11
Q

When do you say that urine is metastable

A

When urine is between solubility product and formation product

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12
Q

Steps of crystal formation

A

Nucleation - crystal formation on epithelial , foreign bodies, other crystals surfaces

Aggregation - crystal nuclei form into clumps

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13
Q

Location of calcium absorption

A

Small intestine

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14
Q

Hormone responsible for conversion of 25-dihydroxyvitamin D3 to 1,25(OH)2D3

A

Parathyroid hormone

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15
Q

Hormone responsible for proximal tubular reabsorption of calcium and renal phosphate excretion n

A

PTH

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16
Q

Factors influencing intestinal oxalate absorption

A

Luminal calcium
Magnesium
Oxalate degrading bacteria

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17
Q

Biochemistry of absorptive hypercalciuria

A

Normal serum calcium
Normal or suppressed PTH
Normal fasting urinary calcium
Elevated urinary calcium

18
Q

Biochemistry of renal hypercalciuria

A

Impaired renal calcium reabsorption
PTH hypersecretion
Increased fasting hypercalciuria

19
Q

Dx causing resorptive hypercalciuria

A

Primary hyperparathyroidism

20
Q

Indications for metabolic stone evaluation

A

Recurrent stone formers
Strong family hx
Intestinal dx specially if chronic diarrhea
Pathologic skeletal fractures
Osteoporosis
Hx Urinary trat infection with calculi
Hx of gout
Infirm health
Solitary kidney
Anatomical abnormalities
Renal insuffiency

21
Q

Hx taking in stones

A

Predisposing conditions
Medications (calcium, vitamin C, vitamin D, acetazolamide , steroids)
Diet excess
inadequate fluid intake
Excessive fluid loss

22
Q

Metabolic Investigations

A

Metabolic panel - sodium, potassium, chloride, carbon dioxide , blood urea nitrogen , creatinine
Calcium
Parathyroid hormone
Uric acid levels

23
Q

Urine investigations

A

Urinalysis - pH<7.5 (infection lithiasis) , pH<5.5 ( uric acid lithiasis)
Sediment for crystalluria
Urine culture
Urea splitting organisms for infection
Qualitative cystine

24
Q

Radiography findings

A

Radioopaque stones in calcium oxalate , calcium phosphate , magnesium, ammonium phosphate , cystine

Radioluscent stones in urine acid, xanthine, triamterene

Stone analysis

25
Q

Conservative medical management

A

Drink - 3000ml / day to maintain urine output abode 2500ml/day

Medical expulsion therapy when stone <5mm

Low animal protein intake
High fruits and vegetables diet
Restriction of dietary sodium
CHO restriction
Calcium supplement
Decrease oxalate diet
Avoid large doses of vitamin c

26
Q

Medications used in medical expulsion therapy

A

Tamsulosin
NSAIDs
Phytothérapie
Potassium citrate

27
Q

Does dietary calcium restriction decrease stone formation

A

No actually increase it

28
Q

How can dietary calcium help decrease stone

A

By binding intestinal oxalate and decrease its absorption

29
Q

Medications that form stone

A

Inidnavir
Ephedrine
Triamterene
Magnesium trisilicate antacids
Sulfamethoxazole-trimethoprim

30
Q

Medications that provoke stone formation

A

Carbonic anhydrase inhibitors
Topirimate
Furosemide
Vitamin c excess
Vitamin d excess
Laxatives

31
Q

Surgical management of stones in kidney

A

Endoscopy with percutaneous nephrolithotomy or uteroscopy+laser fragmentation

Laparoscopic nephrolithotomy

Open surgery

Extracorporeal shockwave lithotripsy

32
Q

Surgical management of stones in bladder

A

Endoscopic cystolitholapaxy/

Open cystolithotomy

33
Q

Surgical management of stones in ureters

A

Uteroscopy+laser, ballistic or ultrasonic lithotripsy

Open ureterolithotomy

PCNL

34
Q

Surgical management of stones in urethra

A

Endoscopic extraction
Open urethrolithotomy

35
Q

Age group with highest incidence of renal stone in developed countries

A

Young men

36
Q

Predisposing factors for kidney stones

A

Low urine volumes: high ambient temperatures, low fluid intake
Diet: high protein, high sodium, low calcium
High sodium excretion
High oxalate excretion
High urate excretion
Low citrate excretion
Hypercalcaemia
Ileal disease or resection (increases oxalate absorption and urinary
excretion)
Renal tubular acidosis type I
Familial hypercalciuria
Medullary sponge kidney
Cystinuria
Renal tubular acidosis type I (distal) • Primary hyperoxaluria

37
Q

People at risk of bladder stone in developing countries

A

Children

38
Q

Are renal or bladder stone more common in the developed countries b

A

Renal stone

39
Q

Clinical features

A

Asymptomatic
Pain
Hematuria
Acute loin pain radiating to anterior abdomen + hematuria + restlessness ->renal or ureteric colic
Pallor
Sweating
Vomiting

40
Q

What disease is indicated by ureteric colic

A

Obstruction of ureter by calculus or tumor or renal papilla

41
Q

Investigations

A

Plain abdominal x ray for calcium stone
Non contrast CTKUB gold standard
US in unstable patient, young women with undersirable exposition. To radiation
Blood test - calcium, phosphate, uric acid , urea and electrolytes , bicarbonate , parathyroid

Urine - dipstick for proteins, blood, glucose, amino acids

24h urine

Stone for composition

42
Q

Treatment

A

Immédiat -> analgesics , antiemetics
ATBS if surgery
Uteroscopy and stone fragmentation
extracorporeal shock wave lithotripsy
Nephrtomy or stent

6- Renal Medicine (8 decks)

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