Exam 3- Pales- nephrolithiasis Flashcards
Are kidney stones more likley in men or women
men
What are the 4 types of stones
Calcium-80%
uric acid -5-10
strvite 10-15
cystine less than 1%
what causes stones usually
supersaturation
ris factors for Ca stones
hypercalciuria hyperoxaluria hypocitraturia high urine pH low urine volume
what causes hypercalciuria
higher salt in diet higher non-dairy animal protein diet high sucrose content in diet hyperparathyroidism hypercalciuric hypocalcemia
why is RTA I associated with calcium stones
high urine pH
what cause hyperoxaluria
increased intake in high oxalate containing foods
decreased oral Ca intake
why does a high Ca diet help with Ca stones
bind oxalate in diet, then exccreted with stool
What are causes of uric acid stones
hyperuricemia, hyperuricuria
low urine pH
what conditions cause hyperuricemia and uria
gout
polycythemia vera
tumor lysis
what conditions cause a low urine pH
obesity, DM II, high non-dairy animal protein intake
whta cause struvite stones
chronic UTI with urease producing bacteria (Proteus or klebsiella
what type of inheritance is cystinuria
autosomal recessive
what Sx are associated with stones
micro, macro hematuria
sometimes associated with UTI: fever, leukocytosis, pyruia sepsis
what is renal colic
sudden acute severe
non remitting with positional changes
abdominal or back pain
unilateral
how do you Dx kidney stones
clinical presentation
RBC WBC cyrstals
leikocytosis, ARF
imaging
what type of imaging only show calcium
plain films
What is the gold standard for renal stones
CT
Ultrasound is not good for what type stone
ureteral
how do you treat acute attack of kidney stones
pain control nausea control, propulsive therapy(Cach blocker, alpha-blocker)
What do you treat kidney with after acute attack of large stone
lithotripsy for large stones, break up stones
what is a nephrostomy
remove urine from kidney directly because obstruciton form stone is acute and need to buy time
How do you prevent stones
change diet and fluid intake
what labs do you order after stones
hypercalciuria work up
24 hr urine collection Ca urate, oxalate and citrate
What food do you avoid in Ca stone patient
avoid spinach
reduce Na
restrict nondairy animal protein
increase K rich food
What are changes to prevent uric acid stones
increase urine pH
reduce intake animal proteins
increase intake alkali rich foods
oral bicarb
what medications do you use to prevent stone recurrence
thiazides
alloputinol for uric stones
Kcitrate
Mg which bind to oxalate and make soluble
