CVPR First Aid: Kidney stones

Question 1

Basic types of kidney stones

4 listed

Answer 1

Calcium

Ammonium magnesium phosphate

Uric acid

Cystine

Question 2

Complications of Kidney stones

Answer 2

Can lead to severe complications such as hydronephrosis, pyelonephritis

Question 3

Presentation of obstructed kidney stone

Answer 3

Obstructed stone presents with unilateral flak tenderness, colicky pain radiating to groin, hematuria

Question 4

Kidney stone treatment and prevention

Answer 4

Encouraging fluid intake

Question 5

What is the most commmon kidney stone presentation

Answer 5

Calcium oxalate stone in patient with hypercalciuria and normocalcemia

Question 6

Calcium stone precipitates with?

Answer 6

Calcium oxalate citraturia

Question 7

Calcium stone X-ray findings

Answer 7

Radiopaque

Question 8

Calcium stone CT findings

Answer 8

Radiopaque

Question 9

Calcium stone Urine crystal

Answer 9

Shaped like an envelope or dumbbell

Question 10

Calcium stone prevalence

Answer 10

Calcium stones most common (80% of kidney stones)

Question 11

Types of calcium stones

Answer 11

Calcium oxalate

Calcium phosphate

Question 12

What type of calcium stone is most common?

Answer 12

Calcium oxalate

Question 13

Calcium kidney stones associations

Answer 13

Hypocitraturia often associated with ↓ in urine pH

Question 14

Causes of calcium kidney stone

Answer 14

Can result from:

ethylene glycol (antifreeze) ingestion

Vitamin C abuse

Hypocitraturia

Malabsorbtion (Crohn’s Disease)

Question 15

Treatment of calcium kidney stone

3 listed

Answer 15

Thiazides

Citrate

Low-sodium diet

Question 16

Calcium phosphate precipitates with

Answer 16

↑ pH

Question 17

Calcium phosphate kidney stone X-ray findings

Answer 17

Radiopaque

Question 18

Calcium phosphate kidney stone CT findings

Answer 18

Radiopaque

Question 19

Calcium phosphate kidney stone urine crystal

Answer 19

Wedge shaped prism 582

Question 20

Calcium phosphate kidney stone treatment

Answer 20

low-sodium diet, thiazides

Question 21

Ammonium magnesium phosphate kidney stone precipitates with

Answer 21

↑ pH

Question 22

Ammonium magnesium phosphate kidney stone X-ray findings

Answer 22

Radiopaque

Question 23

Ammonium magnesium phosphate kidney stone CT findings

Answer 23

Radiopaque

Question 24

Ammonium magnesium phosphate kidney stone urine crystal

Answer 24

Coffin lid

Question 25

Ammonium magnesium phosphate kidney stone AKA

Answer 25

Struvite

Question 26

Ammonium magnesium phosphate kidney stone prevalence

Answer 26

15% of kidney stones

Question 27

Causes of Ammonium magnesium phosphate kidney stone

Answer 27

Caused by infection with urease (+) bugs (eg, proteus mirabilis, staphylococcus saprphyticus, Klebsiella) that hydrolize urea to ammonia → urine alkalinization

Question 28

Ammonium magnesium phosphate kidney stone special features

Answer 28

Often formm staghorn caliculi

Question 29

Treatment of ammonium magnesium phosphate kidney stone

Answer 29

Eradication of underlying infection

Surgical removal of stone

Question 30

Cystine kidney stone precipitates with

Answer 30

↓pH

Question 31

Cystine kidney stone X-ray findings

Answer 31

Faintly radiopaque

Question 32

CT findings Cystine kidney stone

Answer 32

Moderately radiopaque

Question 33

Cystine kidney stone urine crystal

Answer 33

Hexagonal

“Sixtine stones have six sides”

Question 34

Causes of Cystine kidney stone

Answer 34

Hereditary (autosomal recessive) condition in which Cysteine-reabsorbing PCT transporter loses function, causing cytinuria

Transporter defect also results in poor reabsorption of Ornithine, Lysine, Arginine (COLA)

Cysteine is poorly soluble so stones formm in the urine

Question 35

Cystine kidney stone onset

Answer 35

Typically begins in childhood

Question 36

Cystine kidney stone special features

Answer 36

Can form staghorn caliculi

Question 37

Cystine kidney stone special test

Answer 37

Sodium cyanide nitroprusside test (+)

Question 38

Treatment of Cystine kidney stone

Answer 38

Low sodium diet

Alkalinization of urine

Chelating agents if refractory

Question 39

Uric acid kidney stones precipitate with?

Answer 39

↓pH

Question 40

Uric acid kidney stones X-ray findings

Answer 40

radiolUcent

Question 41

Uric acid kidney stones CT findings

Answer 41

Minimally visible

Question 42

Uric acid kidney stones urine crystal

Answer 42

Rhomboid or rosettes

Question 43

Uric acid kidney stones prevalence

Answer 43

≈5% of all stones

Question 44

Risk factors for Uric acid kidney stones

Answer 44

↓ urine volume

Arid climates

Acidic pH

Question 45

Uric acid kidney stones are associated with?

Answer 45

Strong association with hyperuricemia (eg, gout)

Often seen in disease with high cell turnover (eg, leukemia)

Question 46

Treatment of Uric acid kidney stones

Answer 46

Alkalization of urine

Allopurinol

Question 47

Pictures of urine crystals

Answer 47

582

Question 48

What is hydronephrosis

Answer 48

Distention/dilation of renal pelvis and calyces

Dilation occurs proximal to the site of pathology

Question 49

Causes of hydronephrosis

Answer 49

Usually caused by urinary tract obstruction (eg, renal stones, severe BPH, congenital obstructions, cervical cancer, injury to uterer)

Other causes include;

retroperitoneal fibrosis

Vesicoureteral reflux

Question 50

Signs of hydronephrosis

Answer 50

Creatinine becomes elevated if obstruction is bilateral or if patient has an obstructed solitary kidney

Leads to compression and possible atrophy of renal cortex and medulla

Question 51

What is the most common renal malignancy?

Answer 51

Renal cell carcinoma

Question 52

Renal cell carcinoma most commonly occurs in?

Answer 52

Men 50-70

↑incidence with smoking and obesity