Kidney Stones Flashcards
Functions of the kidneys:
Maintain fluid, electrolyte, and solute balance
Filtration of blood
Regulation of water homeostasis
Regulate blood pressure
Maintain acid-base balance
Hormone production
The kidneys secrete vasopressin also known as _____ which is stimulated by high osmolality.
ADH
Steps of the renin-angiotensin cascade system (3):
- Glomerulus secretes renin when blood volume decreases
- Renin stimulates the formation of angiotensin (vasoconstrictor)
- Angiotensin stimulates aldosterone to reabsorb sodium and fluid and also increases blood pressure
The kidney produces 2 important hormones:
Erythropoietin (EPO) and the active form of vitamin D
EPO stimulates what?
RBC production
T/F: Angiotensin is a vasodilator
False, vasoconstrictor
Nephrolithiasis are:
Kidney stones
Types of kidney stones
Calcium stones
Uric acid stones
Struvite stones
Cystine stones (rare)
Struvite stones ONLY form in the presence of _______, not very common.
Bacteria
Cystine kidney stones caused by a very rare genetic condition called ______.
Cystinuria, excess cystine excretion in urine
Kidney stone risk factors:
Male gender (it’s also increasing in women)
Family history/Genetics
Obesity
Oliguria (low urine excretion)
Hypercalciuria (high)
Hyperoxaluria (high)
Hyperuricosuria (high)
Hypocitraturia (low)
Urine pH
Types of calcium kidney stones (2):
Calcium oxalate (most common)
Calcium phosphate
T/F: Oliguria (low urine excretion) encourages kidney stones because it can lead to a concentration of substances accumulating in the urine that promote stone formation.
True
Hypocitraturia increases the risk of calcium oxalate stones because citric acid prevents _______ from binding to oxalate.
Calcium
Estrogen, particularly in premenopausal women, is thought to ________ urinary citrate levels, which helps prevent the formation of kidney stones. This is why post-menopausal women have an increased risk of kidney stones (hypocitraturia)
Increase
MNT for kidney stones
Monitor results 24hrs from collection
Fluid intake over 2.5 L/day to dilute solute concentration
Urine volume for kidney stones should exceed ___ L/day.
2
Cranberry juice helps treat _____ stones as it has anti-microbial properties.
Struvite
Citrus drinks helps prevent ______ stones from forming.
Calcium
Foods to limit/avoid for kidney stones:
Foods high in oxalates
Ca supplements in large doses
Vitamin C supplements in large doses
High sodium diets
High animal protein diets
Excessive fructose
Vitamin C in high doses can ______ risk of kidney stones.
Increase
T/F: Caffeine increases the risk of kidney stone since it increases Ca excretion.
F, it is a diuretic so it also promotes urine excretion
What increases uric acid excretion and increases the risk for uric acid stones (3)?
High animal protein diets
High purine foods
High fructose diets
Vitamin C in high doses increases _______ excretion in the urine, promoting calcium oxalate stones via hyperoxaluria.
Oxalate
If we consume adequate potassium, we excrete ____ calcium in the urine.
Less
Foods to consume with kidney stones:
Potassium
Calcium
Magnesium
Probiotics
Potassium is found more in ____ foods, which tend to reduce the risk of kidney stones.
Plant
What prevents oxalate absorption (4) which can reduce the risk of calcium-oxalate stones?
Potassium
Calcium
Magnesium
Probiotics
High oxalate foods that should be limited:
Spinach
Berries
Chocolate
Wheat bran
Tea
Nuts
Turmeric
Beets
Rhubarb
High purine foods that should be limited:
Animal protein
MFP
Shellfish/Fish
Organ meats
If there are excess minerals in our body, the body will ______ more.
Excrete
If there are a low amount of minerals in our body, the body will _____ more from the kidneys or small intestine.
Reabsorb
T/F: The kidneys can sense blood volume, solute volume, and electrolyte volume
True, and it adjusts accordingly
Kidneys excrete _____ in the urine.
Toxins
A high osmolality in the blood, that means there is a high _____ concentration (glucose, nitrogenous waste, electrolytes, or other substances) in the blood.
Solute
In response to a high solute concentration in the blood, the kidneys will secrete _________ also known as _____ to reabsorb more back into the bloodstream to help dilute the blood solute concentration.
Vasopressin, ADH
Kidneys filter and excrete out different types of nitrogenous waste products such as (3):
Urea
Ammonia
Creatinine
The renin-angiotensin cascade system starts in the _______.
Kidneys (glomerulus)
If kidneys sense a low blood volume, it will promote the formation of _______ to raise BP through the cascade.
Renin
Kidneys remove acid from the _____ and excrete it in the urine.
Blood
EPO treats _____ of chronic disease.
Anemia
The active form of vitamin D is ________.
Calcitriol
The glomerulus is the _____ unit of the kidneys.
Filtering
The majority kidney stones are _______ stones, and of that, the most common ones are ________ ________ stones.
Calcium, Calcium oxalate
Stone ________ is common in obese patients.
Recurrence
______ and adequate fluid intake are controllable factors in preventing kidney stones.
Obesity
Citric acid is _________ against kidney stones, which is why low levels increase the risk of kidney stones.
Protective
Low pH, acidic urine, increases the risk of ______ acid stones.
Uric
High pH, basic urine, increases the risk of calcium ______ stones.
Phosphate
Monitoring 24hr urine samples, help determine the type of stone, due to measuring ____ concentrations.
Solute
Adequate _____ intake, helps prevent any type of stone development, by diluting solute concentration in the urine. Patients should be producing 2L of urine a day.
Fluid
T/F: Spinach is a great source of calcium.
F, the Ca and Mg in spinach bind to oxalates and prevent them form being excreted in the urine (helps limit calcium oxalate stones)
T/F: Patients with kidney stones, should reduce calcium consumption
F, patients should still consume adequate amounts of Ca.
Patients should avoid Ca supplements at doses higher than ____ mg. If not, they will excrete more Ca in the urine and are more at risk for stones.
500
High animal protein diets promotes _____ acid excretion and should be limited.
Uric
High sodium diets promote increased _____ excretion and should be limited.
Calcium
T/F: excessive glucose consumption increases uric acid excretion.
F, Fructose
Vitamin C contributes to ___________.
Hyperoxaluria
Adequate Ca and Mg in the diet can help prevent calcium oxalate stones because Ca and Mg bind to oxalate in the _________ and the complex are excreted through the stool instead of the urine.
Intestines
Plant foods can help reduce the _____ of the urine, while animal proteins do the opposite.
Acidity
Probiotics can prevent the _______ of oxalate, promoting the secretion through the stool, rather than the urine.
Absorption
When someone develops a stone:
- Pass in urine (depending on size)
- Surgically remove
- Locate and treat (shock wave lithotripsy)
Shock wave lithotripsy treats stones by using ____ to diffuse stones.
Water
Patients at risk for developing stones should not consume more than _____ mg of Vitamin C a day.
500
T/F: RD’s can prevent the onset of kidney stones.
False, RD’s mainly prevent the recurrence of kidney stones
