CUA MEDICAL MANAGEMENT OF Kidney stone patient 2016 Flashcards
limited Evaluation for first time stone-formers?
UA + Culture, serum lytes, Serum Ca, Serum creatinine
Who should have in depth metabolic evaluation?
- Any patient with stone interested and willing
- children<18
- bilateral or multiple stones
- Recurrent stones ( 2 or more episodes)
- Non-calcium stones
- pure calcium phosphate stones
- any complicated stone episode that resulted in a severe( if even temporary acute kidney injury, spesis, hospitalization, complicated hospital admission)
- any stone requiring PCNL (due to infectious nature of Struvite, metaabolci evaluation is not needed in this group)
- Stones in the setting of solitary kidney
- patients with renal insufficiency
- history of kidney stones and systemic disease that increases the risk of kidney stones( gout, osteoprosis, bowel disorders, hyper PTH, renal tubular acidosis,
- occupation where public safety at risk( pilots, Air traffic controllers, military personnel
is routine metabolci evaluation recommended for struvite stones?
Nope
C+ S + imaging
What serum tests does in depth metabolic evluation entail?
- Cr, Na, K, Cl, Ca, Alb, Uric acid, bicarb
- PTH if Ca high normal or abnormaly elevated
- Vit D if low normal serum Ca or elevated serum PTH
What 24 hour urine tests does in depth metabolic evluation entail?
Volume, Cr, Ca, Na, K, Oxalate, Citrate, UA, Mg, Cystine( if suspecting cystine stone)
What do you learn from spot urine when doing stone work up? (in depth)
Urine pH
UA
Specific gravity
How many 24 hour urines?
two,
but be practical and at least obtain one
Should you send stones for analysis?
In short yes
if patient passes ask them to keep and if you remove them send them
Should you repeat stone analysis if patient has recurrent stones?
yes,
22% of patients stone composition changes overtime
What is the “stone clinic effect”?
counselling on appropriate fluid intake to avoid dehydration and dietary excesses can significantly reduce stone recidivism
Does making specific dietary recommendations by a dietician matter
Yes, shown to reduce recurrences
What is the recommended fluid intake and output for prevention of recurrences?
2.5-3 L intake for a UO of 2.5 L ( shown to reduce stone risk by 61%)
Is restriction of coffee, tea and alcohol recommended
no, some studies show they help, some dont, but dont need to rstrict as long as they are drinking enough water
What is the dietary calcium intake goal
1000-1200 in diet
How should calcium supplementation be given?
Should be taken at mealtimes, conflicting evidence re Cacarb vs ca-citrate
Is nephrolithiasis associated with increased risk of fractures?
Yes, particularly if Vit D deficient
HR of 1.55
Is vitamin D recommended for stone formers?
In CaOX stone formers with documented vitD deficiency, repletion is appropriate but should monitor 24 hour urine for hypercalciuria
Which has the highest purine content FIsh chicken or beef
Fish, causes inc UA excretion
