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Renal > Kidney Stones > Flashcards

Kidney Stones Flashcards

1
Q

What are three forms of Urinary Tract Crystallization?

A
  • Nephrolithiasis/Urolithiasis - stone forming disorders/drugs
  • Nephrocalcinosis - medullary sponge kidney
  • Bladder Stones - bladder dysfunction
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2
Q

Medullary sponge kidney is associated with malformation of the _____ tubules

A

distal

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3
Q

What are some key factors associated with the etiology of stone formation?

A
  • Urinary supersaturation
  • Crystal retention at the renal papilla
  • Associated risk factors
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4
Q

What are the most common compositions of kidney stones?

Which requires a predisposing factor to form?

A

Mostly calcium oxalate

30% have calcium phosphate

Urates are third most common

Struvite next most common - Requires urea secreting bacteria to form

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5
Q

WHat are some demographic associations with kidney stones?

A
  • Men> women (about 2:1 although has decreased recently)
  • White race more commonly affected
  • Peak incidence in middle age
  • Substantial regional variations
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6
Q

Lifetime prevalence of kidney stones = __-__%

Recurrence rates exceed __% in 5 years

A

5-15%

50%

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7
Q

Is the prevalence of kidney stones increasing or decreasing?

A

Increasing

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8
Q

What drugs can form stones?

A

Indinavir

Acyclovir

Triamterene

Sulfamethoxazole

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9
Q

What are some genetic diseases causing stones?

A

Cystinuria - L-cystine

Primary hyperoxalosis - calcium oxalate

Dent Disease - calcium oxalate or calcium phsophate

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10
Q

Describe L-Cystine stone disease

A

Transporter system for recovering L-Cystine is defective - build up forms heagonal plates

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11
Q

What are the three types and two possible defective genes associated with L-Cystine stone disease and what is their prevalence?

A
  • Type A (38%) - SLC 3A1 - Recessive, targeting protein
    • Proximal tubule - high affinity and low capacity
  • Type B (47%) - SLC7A9 - incompletely dominant, transporter
    • Proximal tubule - Low affinity and high capacity
  • Type AB (14%)
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12
Q

Primary hyperoxalosis/hyperoxaluria is a rare genetic disorder which leads to excessive synthesis of ______ ______

A

endogenous oxalate

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13
Q

What are the 3 known gene defects associated with primary hyperoxalosis and what do they cause?

A
  • PH1 - 80% - alanine-glyoxylate aminotransferase (AGXT) defect
  • PH2 - 10% - glycoxylate reductase/hydroxy pyruvate reductase (GRHPR) defect
  • PH3 - 10% - 4-hydroxy-2-oxaloglutarate aldolase (HOGA1) defect
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14
Q

Why can calcium oxalate easily cause supersaturation in kidney?

A

Solubility of calcium oxalate in water is very low

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15
Q

As urine volume increases, relative supersaturation for calcium oxalate _______

A

decreases

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16
Q

What are some diet risk factors associated with hyperoxaluria?

A
  • Low fluid intake
  • High salt intake
  • High protein intake
  • Low calcium intake
  • High oxalate intake
17
Q

Increasing calcium in the diet ______ risk of Kkidney stones

A

decreases

18
Q

How do kidney stones present on physical exam?

A
  • Distress
  • Fever
  • Hematuria
  • Elevated WBCs
  • Elevated serum creatinine
  • Nausea, vomiting
19
Q

What are the two best diagnostic tools for kidney stones?

A

CT scan (best)

Ultrasound

20
Q

What can inhibit all stone types?

What inhibits calcium stones specifically?

A

Citrate inhibits all

Magnesium inhibits calcium stones

21
Q

What is the most common urinary abnormality in calcium oxalate stone formers?

A

Low urine volume

22
Q

How are kidney stones treated?

A

Removal of stone

Symptom control

23
Q

What are acute treatments to stone formation?

A
  • Noninvasive
    • pain control and fluids
    • Medical expulsive therapy
    • Dissolution therapy
  • Extra-corporeal shock wave lithotripsy (ESWL)
  • Uretoscopy
  • Percutaneous approach
  • Surgery
24
Q

What are some chronic treatments to stone formation?

A
  • Dilution
  • Alkalinize urine
  • Cystine binding drugs (disulfide exchange)
25
Q

How do you treat uric acid crystals?

A
  • Dilution
  • low protein diet
  • alkalinize urine
  • Xanthine oxidase inhibitors
    • Allopurinol
    • Febuxostat
26
Q

How do you treat struvite crystals?

A
  • Dilution
  • Sterilize urine (eliminate bacteria)
  • Remove residual stone material (surgical)
  • Adjunctive therapies
27
Q

How do you treat calcium stones?

A
  • Dilution
  • Maintain normal calcium intake
  • Reduce urine calcium exretions
  • Reduce urine oxalate
  • Increase urine citrate
28
Q

High water intake _____ stone recurrence rates

A

decreases

29
Q

High protein intake _____ calcium excretion in the urine

A

increases

30
Q

Increased duration of treatment with thiazide diuretics corresponds to ______ stone recurrence compared to placebo

A

decreased

Renal (17 decks)

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