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EAMC Urology > EAU 2020 Urolithiasis > Flashcards

EAU 2020 Urolithiasis Flashcards

1
Q

Non-infection stones

A

Calcium oxalate
Calcium phosphate
Uric acid

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2
Q

Infection stones

A

MAP
Carbonate apatite
Ammonium urate

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3
Q

Stones from Genetic causes

A

Cystine
Xanthine
2,8-Dihydroxyadenine

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4
Q

MINERAL NAME

Calcium oxalate monohydrate

A

Whewellite

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5
Q

MINERAL NAME

Calcium oxalate dihydrate

A

Weddelite

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6
Q

MINERAL NAME

Basic calcium phosphate

A

Apatite

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7
Q

MINERAL NAME

Calcium hydroxyl phosphate

A

Carbonate apatite

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8
Q

MINERAL NAME

b-tricalcium phosphate

A

Whitlockite

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9
Q

MINERAL NAME

Carbonate apatite phosphate

A

Dahllite

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10
Q

MINERAL NAME

Calcium carbonate

A

Aragonite

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11
Q

MINERAL NAME

Uric acid/uric acid dihydrate

A

Uricite

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12
Q

MINERAL NAME

Magnesium ammonium phosphate

A

Struvite

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13
Q

MINERAL NAME

Magnesium acid phosphate trihydrate

A

Newberyite

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14
Q

MINERAL NAME

Magnesium ammonium phosphate monohydrate

A

Dittmarite

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15
Q

Radiopaque stones

A

Calcium oxalate dihydrate
Calcium oxalate monohydrate
Calcium phosphates

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16
Q

Poor radiopacity

A

Magnesium ammonium phosphate
Apatite
Cystine

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17
Q

Radiolucent stones

A 
Uric acid
Ammonium urate
Xanthine
2,8-Dihydroxyadenine
Drug-stones
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18
Q

Repeat stone analysis in patients presenting with:

A

Recurrent stones despite drug therapy
Early recurrence after complete stone clearance
Late recurrence after a long stone-free period because stone composition may change

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19
Q

Pregnant women: first and second line imaging

A

1st: Ultrasound
2nd: MRI
Last option: low-dose CT

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20
Q

Children: diagnosis recommendations in children

A

Complete metabolic evaluation based on stone alaysis
Collect stone material to classify stone type
First-line imaging: ultrasound (kidney, fluid-filled bladder, ureter)
KUB x-ray or low dose non-contrast CT if ultrasound will not provide information

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21
Q

Pain relief: first drug of choice

A

NSAIDs and paracetamol: ex. metamizoledipyrone.

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22
Q

Pain relief: second drug of choice

A

Opiates: hydromorphine, pentazocine, or tramadol (NOT pethidine)

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23
Q

Pain relief: when to offer renal decompression or URS stone removal

A

In case of analgesic refractory colic pain

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24
Q

Two options for urgent decompression of obstructed collecting systems:

A

Indwelling ureteral stent placement

Percutaneous nephrostomy tube placement

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25
Q

Obstructed collecting systems: definitive treatment of stones should be delayed until ______.

A

Sepsis resolves

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26
Q

After decompression of obstructed collecting system, collect _______ and start ________.

A

Urine for antibiogram
Antibiotics immediately + intensive care, if necessary.

Re-evaluate antibiotic regimen after antibiogram findings.

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27
Q

Medical expulsive therapy should only be used in _____________.

A

Informed patients if active stone removal is not indicated.

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28
Q

Patients treated with _____, ______, and ______ are more likely to pass stones with fewer colic episodes than those not receiving such therapy.

A

MET:

alpha-blockers (tamsulosin)
calcium-channel inhibitors (nifedipine)
PDE-5 inhibitors (tadalafil)

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29
Q

Offer alpha-blockers as MET for _________ stones.

A

Ureteral (distal) , > 5 mm

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30
Q

Irrigation chemolysis has been in limited clinical use to dissolve _____.

A

Struvite stones

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31
Q

Uric acid stones > 5 mm can be dissolved by oral alkalinisation of urine above pH ___.

A

7.0

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32
Q

Inform patient on how to monitor _________ by __________ to modify the dosage of alkalising medication.

A

urine pH, dipstick

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33
Q

Oral chemolitholysis is based on alkalinisation of urine using _____ or ______, and pH should be adjusted to _____.

A

Alkaline citrate
Sodium bicarbonate

pH 7.0-7.2

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34
Q

Carefully monitor patients during/after chemolysis of _________.

A

Uric acid stones

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35
Q

Combine oral chemolysis with _____ in larger ureeral stones if active intervention is not indicated.

A

Tamsulosin

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36
Q

ESWL: _________ prevents renal injury.

A

Stepwise power ramping

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37
Q

Optimal shock wave frequency is:

A

1.0 - 1.5 Hz

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38
Q

___________ between the cushion of the treatment head and the patient’s skin is important.

A

Proper acoustic coupling

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39
Q

Ensure correct use of _____________ monitoring during ESWL.

A

Fluoroscopic and/or ultrasonographic

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40
Q

Proper analgesia improves ESWL treatment results by:

A

Limiting pain-induced movements and excessive respiratory excursions

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41
Q

Prescribe antibiotics prior to ESWL in case of ________ or ________

A

Infected stones or bacteriuria

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42
Q

Stenting before ESWL does not improve ______ but may reduce ________

A

Does not improve SFRs

May reduce steinstrasse formation

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43
Q

ESWL complications related to stone fragments:

A

Steinstrasse
Regrowth of fragments
Renal colic

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44
Q

ESWL complications, infectious:

A

Bacteriuria in non-infection stones

Sepsis

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45
Q

ESWL complications, tissue effect:

A

Renal: hematoma symptomatic/asymptomatic
Cardiovascular: dysrhythmia, morbid cardiac events
GI: bowel perforation, liver, spleen hematoma

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46
Q

Antegrade URS is an option for:

A

Large, impacted, proximal ureteral calculi

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47
Q

The most effective lithotripsy system is the:

A

Holmium:yttrium-aluminium-garnet (Ho:YAG) laser, effective in all stone types.

Pneumatic and US systems: high disintegration efficacy URS, but stone migration is common problem

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48
Q

Is routine stenting necessary before URS?

A

No.

BUT: it improves URS management of stones, improves SFR, and reduces intraop complications.

“I hate stents! 😤 “ - JBM

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49
Q

Stents should be inserted in patients who are:

A

At increased risk of complications:

  • Ureteral trauma
  • Residual fragments
  • Bleeding
  • Perforation
  • UTIs
  • Pregnancy
  • All doubtful cases
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50
Q

________ reduce the morbidity and increase the tolerability of ureteral stents.

A

Alpha-blockers

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51
Q

_________ accelerates the spontaneous passage of fragments and reduces episodes of colic/stent-related symptoms.

A

MET

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52
Q

Use _____ lithotripsy for flexible URS.

A

Ho:YAG laser

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53
Q

Perform stone extraction only under:

A

Direct endoscopic visualization of the stone.

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54
Q

DO NOT insert a stent in _______ URS cases.

A

Uncomplicated

“I hate stents! 😤 “ - JBM

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55
Q

When ESWL is not indicated or has failed, or when upper urinary tract is not amenable to retrograde URS, use _____ removal of ureteral stones.

A

Percutaneous antegrade removal

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56
Q

_________ therapy must be discontinued before PCNL.

A

Anti-coagulant therapy

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57
Q

Contraindications to PCNL:

A

Untreated UTI
Tumor in the access tract area
Potential malignant kidney tumor
Pregnancy

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58
Q

Safer PCNL position: chupine or prone?

A

Both are equally safe.

Prone: more options for puncture, preferred for upper pole or multi-access

Supine: allows simultaneous retrograde access to collecting system using fURS

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59
Q

Tubeless PCNL

A

PCNL without an NT.

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60
Q

Totally tubeless PCNL

A

PCNL without an NT and ureteral stent.

In uncomplicated cases, results in shorter hospital stay, with no disadvantages reported.

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61
Q

Intraop irrigation pressure ____ mmHg and unobstructed post-op urinary drainage may be important factors in preventing ____

A

< 30 mmHg

Post-op sepsis

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62
Q

Bleeding after PCNL may be treated by _______. For severe bleeding, ________ may be necessary.

A

Briefly clamping the NT.

Super-selective embolic occlusion of the arterial branch

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63
Q

PCNL with small instruments: lower _____ but longer ______.

A

Lower blood loss, longer duration.

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64
Q

Perform ______ when starting PCNL to assess stone comprehensiveness and anatomy of the collecting system to ensure safe access.

A

Pre-procedural imaging + contrast medium where possible or retrograde study

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65
Q

Perform a tubeless or totally tubeless PCNL in _______ cases.

A

Uncomplicated

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66
Q

Obtain ____ or ____ before treatment/ stone removal procedure is planned

A

Urine culture or urinary microscopy

67
Q

Treat ______ prior to stone removal.

A

UTIs

68
Q

Offer perioperative antibiotic prophylaxis to all patients undergoing ______.

A

Endourological treatment

69
Q

Procedures with an elevated risk of hemoarrhage or perinephric hematoma if with uncorrected bleeding diathesis:

A 
SWL
PNL
Percutaneous nephrostomy
Laparoscopic surgery
Open surgery
70
Q

Low-risk bleeding procedures

A 
Cystoscopy
Flexible cystoscopy
Ureteral catheterisation
Extraction of ureteral stent
URS
71
Q

High-risk bleeding procecures

A

ESWL
PNT
PCNL

72
Q

________ is the preferred intervention if stone removal is essential and anti-thrombotic therapy cannot be discontinued.

A

Retrograde flexible URS

73
Q

Hard, SWL resistant stones

A

Brushite
Calcium oxalate monohydrate
Cystine
Homogenous stones with a high density on CT

Alternative treatment: RIRS or URS

74
Q

URS, contraindications

A

None. 💪

Apart from general problems, for example with general anaesthesia or untreated UTIs, URS can be performed in all patients without any specific contraindications.

75
Q

Indications for active removal of URETERAL stones:

A 
Stones with low likelihood of spontaneous passage
Persistent pain despite analgesic meds
Persistent obstruction
Renal insufficiency (RF, bilateral obstruction, or single kidneney)
76
Q

Compared to ESWL, URS has a better chance of __________ with a single procedure.

A

Achieving stone-free status

77
Q

URS has higher ______ compared to ESWL.

A

Complication rate

78
Q

In cases of severe obesity, use _____ as first-line therapy for ureteral (and renal) stones.

A

URS

79
Q

Treatment:

Proximal ureteral stone: > 10 mm

A
  1. URS

2. SWL

80
Q

Treatment:

Proximal ureteral stone: < 10 mm

A

SWL or URS

81
Q

Treatment:

Distal ureteral stone: > 10 mm

A
  1. URS

2. SWL

82
Q

Treatment:

Distal ureteral stone: < 10 mm

A

SWL or URS

83
Q

Dissolution of stones through pharmacological treatment is an option for _____ stones only.

A

Uric acid stones only

84
Q

Indications for active removal or RENAL stones:

A

stone growth;
stones in high-risk patients for stone formation;
obstruction caused by stones;
infection;
symptomatic stones (e.g., pain or haematuria)
stones > 15 mm;
stones < 15 mm if observation is not the option of choice;
patient preference;
comorbidity;
social situation of the patient (e.g., profession or travelling);
choice of treatment.

85
Q

The following can impair successful stone treatment:

Thanos FAQ

A 
Steep infundibular-pelvic angle
Long calyx
Long skin-to-stone distance
Narrow infundibulum
SWL resistant stones (CaOxMono, brushite, cystine)
86
Q

Stones with density _______ on NCCT are less likely to be disintegrated by ESWL.

A

> 1000 HU (and with high homogeneity)

87
Q

First-line treatment for larger renal stones > 2cm

A

PCNL

88
Q

Kidney stone, non-lower pole: > 20 mm

A
  1. PCNL

2. RIRS or SWL

89
Q

Kidney stone, non-lower pole: 10 - 20 mm

A

SWL or Endourology

90
Q

Kidney stone, non-lower pole: < 10 mm

A
  1. SWL or RIRS

2. PCNL

91
Q

Lower pole kidney stone: > 20 mm

A
  1. PCNL

2. RIRS or SWL

92
Q

Lower pole kidney stone: < 10 mm

A
  1. SWL or RIRS

2. PCNL

93
Q

Lower pole kidney stone: 10 - 20 mm, unfavorable factors

A
  1. Endourology

2. SWL

94
Q

Lower pole kidney stone: 10 - 20 mm, no unfavorable factors

A

SWL or endourology

95
Q

Offer laparoscopic or open surgical stone removal in rare cases in which:

A

ESWL, URS, or PCNL fail or are unlikely to successful

96
Q

Steinstrasse is:

A

An accumulation of stone fragments or stone gravel in the ureter, and may interfere with the passage of urine.

97
Q

______ increases stone expulsion and reduces the need for endoscopic intervention for steinstrasse.

A

MET

98
Q

Steinstrasse + UTI/fever should be treated preferably with:

A

PNT

99
Q

Treat steinstrasse when:

A

Large stone fragments are present.

Options: SWL or URS (in absence of signs of UTI).

100
Q

Perform imaging after ESWL or URS to determine ________.

A

Presence of residual fragments

101
Q

Treat all uncomplicated cases of urolithiasis in pregnancy:

A

Conservatively (except when there are clinical indications for intervention)

102
Q

Perform _____ to remove large renal stones in patients with urinary diversion

A

PCNL

103
Q

Patients undergoing urinary diversion and/or suffering from neurogenic bladder are at risk of ______.

A

Recurrent stone formation

104
Q

Common allergy in myelomeningocele patients.

A

Latex allergy

105
Q

For patients with transplanted kidneys with stones, offer:

A

Any of the contemporary options: ESWL, fURS, PCNL

106
Q

Special problems in stone removal:

Calyceal diverticulum

A

SWL, PCNL, or RIRS, and also laparoscopic retroperitoneal surgery

107
Q

Special problems in stone removal:

Horseshoe kidney

A

SWL, PCNL, or RIRS

Passage after SWL might be poor

108
Q

Special problems in stone removal:

Stones + UPJO

A

PCNL + percutaneous endopyelotomy or open reconstructive surgery

URS + endopyelotomy with Ho:YAG laser

Incision with Acucise balloon catheter

Open pyeloplasty + stone removal

109
Q

Children: first-line for single ureteral stones < 10 mm

A

ESWL (if localisation is possible)

110
Q

Children: second-line for single ureteral stones < 10 mm

A

URS

111
Q

Children: renal stones with diameter up to 20 mm (~300 mm2)

A

SWL

112
Q

Children: renal stones with diameter >20 mm (~300 mm2)

A

PCNL

113
Q

Children: renal stones with diameter <20 mm (~300 mm2) in all locations, alternative

A

Retrograde renal surgery

114
Q

General preventive measures: fluid intake/drinking advice

A 
Fluid amount: 2.5-3.0 L/day
Circadian drinking
Neutral pH beverages
Diuresis: 2.0-2.5 L/day
Specific weight of urine: < 1010 g/day
115
Q

General preventive measures: Nutritional advice for a balanced diet

A 
Balanced diet
Rich in vegetables and fibre
Normal calcium content: 1-1.2 g/day
Limited NaCl content: 4-5 g/day
Limited animal protein content: 0.8-1.0 g/kg/day
116
Q

General preventive measures: Lifestyle advice to normalise general risk factors

A

BMI: Retain a normal BMI level
Adequate physical activity
Balancing of excessive fluid loss

117
Q

Vegetarian diet ______ urinary pH

A

Increases (alkaline content).

118
Q

Calcium oxalate stone formers should ______ intake of Vitamin C.

A

Avoid!

119
Q

Excessive consumption of animal protein can cause:

A

Hypocitraturia
Low urine pH
Hyperoxaluria
Hyperuricosuria

(Favoring stone formation)

120
Q

Should calcium intake be restricted?

A

NO.

121
Q

High intake of sodium affects urine composition:

A

Calcium excretion is increased by reduced tubular reabsorption;

Urinary citrate is reduced due to loss of bicarbonate;

Increased risk of sodium urate crystal formation.

122
Q

Alkaline citrates

A

R:
Alkalinisation
Hypocitraturia
Inhibition of calcium oxalate crystallisation

D:
5-12 g/d (14-36 mmol/d)
Children: 0.1-0.15 g/kg/d

S/SE:
Daily dose for alkalinisation depends on urine pH

ST:
Calcium oxalate
Uric acid
Cystine

123
Q

Allopurinol

A

R:
Hyperuricosuria
Hyperuricaemia

D:
100-300 mg/d
Children: 1-3 mg/kg/d

S/SE:
100 mg in isolated hyperuricosuria
Renal insufficiency demands dose correction

ST:
Calcium oxalate
Uric acid
Ammonium urate 
2,8-Dihydroxyadenine
124
Q

Calcium

A

R:
Enteric hyperoxaluria

D:
1000 mg/d

S/SE:
Intake 30 min before meals

ST:
Calcium oxalate

125
Q

Captopril

A

R:
Cystinuria
Active decrease of urinary cystine levels

D:
75-150 mg

S/SE:
Second-line option due to significant side effects

ST:
Cystine

126
Q

Febuxostat

A

R:
Hyperuricosuria
Hyperuricaemia

D:
80-120 mg/d

S/SE:
Acute gout contraindicated, pregnancy, xanthine stone formation

ST:
Calcium oxalate
Uric acid

127
Q

L-Methionine

A

R:
Acidification

D:
600-1500 mg/d

S/SE:
Hypercalciuria, bone demineralisation, systemic acidosis. No long-term therapy

ST:
Infection stones
Ammonium urate
Calcium phosphate

128
Q

Magnesium

A

R:
Isolated hypomagnesiuria Enteric hyperoxaluria

D:
200-400 mg/d
Children: 6 mg/kg/d

S/SE:
Renal insufficiency demands dose correction. Diarrhoea, chronic alkali losses, hypocitraturia

ST:
Calcium oxalate

129
Q

Sodium bicarbonate

A

R:
Alkalinisation
Hypocitraturia

D:
4.5 g/d

S/SE:
N/A

ST:
Calcium oxalate
Uric acid
Cystine

130
Q

Pyridoxine

A

R:
Primary hyperoxaluria

D:
Initial dose
5 mg/kg/d
Max. 20 mg/kg/d

S/SE:
Polyneuropathia

ST:
Calcium oxalate

131
Q

Thiazide (Hydrochlorothiazide)

A

R:
Hypercalciuria

D:
25-50 mg/d
Children: 0.5-1 mg/kg/d

S/SE:
Risk for agent- induced hypotonic blood pressure, diabetes, hyperuricaemia, hypokalaemia, followed by intracellular acidosis and hypocitraturia

ST:
Calcium oxalate
Calcium phosphate

132
Q

Tiopronin

A

R:
Cystinuria
Active decrease of urinary cystine levels

D:
Initial dose
250 mg/d
Max. 2000 mg/d

S/SE:
Risk for tachyphylaxis and proteinuria

ST:
Cystine

133
Q

High risk stone formers: general factors

A

Early onset of urolithiasis (especially children and teenagers)
Familial stone formation
Brushite-containing stones (CaHPO4.2H2O)
Uric acid and urate-containing stones
Infection stones
Solitary kidney (the kidney itself does not particularly increase the risk of stone formation, but prevention of stone recurrence is of more importance)

134
Q

High risk stone formers: associated disease

A 
Hyperparathyroidism
Metabolic syndrome
Nephrocalcinosis
Polycystic kidney disease (PKD)
Gastrointestinal diseases (i.e. jejuno-ileal bypass, intestinal resection, Crohn’s disease, malabsorptive conditions, enteric hyperoxaluria after urinary diversion) and bariatric surgery
Increased levels of vitamin D
Sarcoidosis
Spinal cord injury, neurogenic bladder
135
Q

High risk stone formers: Genetically determined stone formation

A 
Cystinuria (type A, B and AB)
Primary hyperoxaluria (PH)
Renal tubular acidosis (RTA) type I
2,8-Dihydroxyadeninuria
Xanthinuria
Lesch-Nyhan syndrome
Cystic fibrosis
136
Q

High risk stone formers: Anatomical abnormalities associated with stone formation

A 
Medullary sponge kidney (tubular ectasia)
Ureteropelvic junction (UPJ) obstruction
Calyceal diverticulum, calyceal cyst
Ureteral stricture
Vesico-uretero-renal reflux
Horseshoe kidney
Ureterocele
137
Q

High risk stone formers: Environmental factors

A

High ambient temperatures

Chronic lead and cadmium exposure

138
Q

Most common metabolic abnormalities associated with calcium stone formation:

A 
Hypercalciuria
Hyperoxaluria
Hyperuricosuria
Hypomagnesiuria
Hypocitraturia
139
Q

Elevated levels of ionised calcium in serum (or total calcium and albumin) require:

A

Assessment of intact PTH to confirm or exclude suspected hyperparathyroidism (HPT).

140
Q

“Acidic arrest” (urine pH constantly < 5.8) may promote:

A

Co-crystallisation of uric acid and calcium oxalate

141
Q

Urine pH levels constantly > 5.8 in the day profile indicate:

A

RTA, provided UTI has been excluded. An ammonium chloride loading test confirms RTA and identifies RTA subtype

142
Q

Hypercalciuria may be associated with ______ or _______.

A

Normocalcemia (idiopathic hypercalciuria, or granulomatous diseases) or hypercalcaemia (hyperparathyroidism, granulomatous diseases, vitamin D excess, or
malignancy).

143
Q

Hypocitraturia (male < 1.7 mmol/d, female < 1.9 mmol/d) may be ______ or secondary to _______.

A

Idiopathic or secondary to metabolic

acidosis or hypokalaemia.

144
Q

Types of hyperoxaluria:

A

Primary hyperoxaluria (oxalate excretion mostly > 1 mmol/day), appears in three genetically determined forms;

Secondary hyperoxaluria (oxalate excretion > 0.5 mmol/day, usually < 1 mmol/day), occurs due to intestinal hyperabsorption of oxalate or extreme dietary oxalate intake

Mild hyperoxaluria (oxalate excretion 0.45-0.85 mmol/day), commonly found in idiopathic calcium oxalate stone formers.

145
Q

Hypomagnesiuria (< 3.0 mmol/day) may be related to:

A

Poor dietary intake or to reduced intestinal absorption (chronic diarrhoea).

146
Q

Prescribe ____ in case of hypercalcuria.

A

Thiazide + alkaline citrates

147
Q

Offer ____ and _____ in enteric hyperoxaluria.

A

Alkaline citrates

Calcium supplement

148
Q

Advise diet with ______ and ______ in enteric hyperoxaluria.

A

Reduced dietary fat and oxalate

149
Q

Prescribe ________ and ______ in case of hypocitraturia.

A

Alkaline citrates and sodium bicarbonate

150
Q

Prescribe ______ in case of hyperuricosuria.

A

Allopurinol

151
Q

Offer _____ as second-line treatment of hypericosuria.

A

Febuxostat

152
Q

Avoid excessive intake of _______ in hypericosuria.

A

Animal protein

153
Q

Prescribe ______ for primary hyperoxaluria.

A

Pyridoxine

154
Q

Struvite/infection stones: Prescribe ____ OR ____ to ensure urinary acidification.

A

Ammonium chloride, 1 g, two or three times daily OR methionine, 200-500 mg, one to three times daily, as an alternative

155
Q

Factors predisposing to struvite stone formation:

A
  • Neurogenic bladder
  • Spinal cord injury/paralysis
  • Continent urinary diversion
  • Ileal conduit
  • Foreign body
  • Stone disease
  • Indwelling urinary catheter
  • Urethral stricture
  • Benign prostatic hyperplasia
  • Bladder diverticulum
  • Cystocele
  • Calyceal diverticulum
  • UPJ obstruction
156
Q

Obligate urease-producing bacteria (consider urease inhibition with AHA 15 mg/kg/day)

A
  • Proteus spp.
  • Providencia rettgeri
  • Morganella morganii
  • Corynebacterium urealyticum
  • Ureaplasma urealyticum
157
Q

Facultative urease-producing bacteria (consider urease inhibition with AHA 15 mg/kg/day)

A
  • Enterobacter gergoviae
  • Klebsiella spp.
  • Providencia stuartii
  • Serratia marcescens
  • Staphylococcus spp.
158
Q

Cystine stones: urine dilution

A

Advise patients to increase their fluid intake so that 24-hour urine volume exceeds 3 L.

159
Q

Cystine stones: alkalinisation

A

Prescribe potassium citrate 3-10 mmol two or three times daily, to achieve pH > 7.5 for patients with cystine excretion < 3 mmol/day.

160
Q

Cystine stones: complex formation with cystine

A

For patients with cystine excretion, > 3 mmol/day, or when other measures are insufficient: prescribe in addition to other measures tiopronin, 250-2,000 mg/day.

161
Q

Active compounds crystallising in urine

A
  • Allopurinol/oxypurinol
  • Amoxicillin/ampicillin
  • Ceftriaxone
  • Quinolones
  • Ephedrine
  • Indinavir
  • Magnesium trisilicate
  • Sulphonamides
  • Triamterene
  • Zonisamide
162
Q

Substances impairing urine composition

A
  • Acetazolamide
  • Allopurinol
  • Aluminium magnesium hydroxide
  • Ascorbic acid
  • Calcium
  • Furosemide
  • Laxatives
  • Methoxyflurane
  • Vitamin D
  • Topiramate
163
Q

Matrix stones: main risk factors

A

Recurrent UTIs, especially due to P. mirabilis or E. coli
Previous surgery for stone disease
Chronic renal failure and haemodialysis

EAMC Urology (7 decks)

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