Genitourinary Disorders

Question 1

Kidney Stone Prevention

Answer 1

1) long-term observational studies that try to correlate certain dietary habits w increased or decreased risk of symptoms
2) short-term lab studies that eval urinary changes in response to diff dietary changes.

Question 2

laboratory eval for kidney stones

Answer 2

–24h urinary calcium
–24h urinary oxalate
= 2 most common precursors of kidney stones.
maybe: serum Mg, urinary uric acid or serum acid.

Question 3

calcium oxalate stones

–principles

Answer 3

• -increase fluid in general = improve solubility of urine
• -reduce urinary calcium w/o putting bone health at risk.
• -reduce urinary oxalate.
• -increase natural inhibitors of crystal formations

Question 4

uric acid stones

Answer 4

• -low purine diet

- -maintain alkaline urine (above pH 6) to increase solubility of uric acid

Question 5

details of kidney stone prevention research & recommendations
INCREASE:

Answer 5

• -coffee!!!
• -black tea
• -milk
• -beer (20-40%)
• -wine (40-60%)
• *Grapefruit juice = RISK, and apple and cranberry = bad.

Question 6

low oxalate diet (to reduce kidney stones)

Answer 6

• -spinach
• -rhubarb
• -beet greens
• -nuts
• -chocolate
• -tea
• -bran
• -strawberries

Question 7

supplements for kidney stones

Answer 7

• -do NOT avoid calcium unless patient has been shown to have absorptive hypercalciuria
• -EVERYONE else calcium increases risk of kidney stones
• -Mg2+ 200-400mg/d
• -citrate is natural inhibitor of stone formation
• -B6 50-150mg/d
• -Vit C

Question 8

Recurrent Urinary Tract Infection

Answer 8

• -cranberry
• -vitmin A (200,000)
• -chinese herbal medicine & UTI in postmenopausal women (acute sinusitis, acute bronchitis as well)
• -nasturtium & horseradish

Question 9

cranberry

–scientific name

Answer 9

vaccinium macrocarpon

Question 10

cranberry

–parts of plant used

Answer 10

ripe fruit (berry)

Question 11

cranberry

–preparations

Answer 11

• -juice (typically diluted & sweetened)

- -powdered whole berry or berry extract

Question 12

cranberry
(vaccinium macrocarpon)
–active constituents

Answer 12

• -flavonoids (anthocyanidins & proanthocyanidins)

- -other = organic acids, Vit C, natural sugars w/ anti-microbial activity

Question 13

cranberry
(vaccinium macrocarpon)
–pharmacology

Answer 13

–only 5% of flavonoids from oral doses show up in urine

Question 14

cranberry
(vaccinium macrocarpon)
–likely mech of action

Answer 14

–proanthocyanidins/ anthocyanidins, inhibit adhesion of some urinary pathogens to epithelial cells.

Question 15

cranberry
(vaccinium macrocarpon)
–unlikely mech of action

Answer 15

–acids, vit C, and microbe-inhibiting sugars probably never reach high enough urinary concentrations

Question 16

Eval UTI

–patients

Answer 16

• -adult women (50X more likely)
• -elderly men & women
• -catheterized pt
• -neurogenic bladder patients

Question 17

Eval UTI

–outcomes

Answer 17

• -frequency of Dx UTIs by laboratory testing only (ex: bacteriuria)
• -frequency of Dx laboratory testing & clinical S&S

Question 18

medical Tx for recurrent UTI

Answer 18

• -low-dose prophylactic antibiotics

- -lifestyle modification (high fluid intake, frequent urination, cotton underwear, etc)