Kidney Stones Flashcards
another name for kidney stones
nephrolithiasis
pathophysiology of kidney stones
saturation, super saturation, nucleation, crystal growth, crystal retention, stone formation
most common kind of kidney stones
calcium stones
causes of calcium stones
- hypercalciuria (high Ca in urine)
- hyperthyroidism/hyperparathyroidism
- excess vitamin D
- glucocorticoid use
- renal tubular acidosis
- idiopathic
3 most common types of stones
calcium, oxalate, uric acid
Causes of oxalate stones
Inflammatory bowel syndrome - causes fat malabsorption - bile acid and fatty acid in GI tract increases permeability to oxalate - also unabsorbed FAs bind to CA so there is less Ca to bind to oxalate
Endogenous synthesis of oxalate is proportional to
Lean body mass
Causes of oxalate stones
excess vitamin c (especially CKD)
Low pyridoxone (B6) - will leave you with excess glyoxylate which turns to oxylate
Eating excess oxylate in your diet
Risk factors for kidney stones
Diabetes
Obesity
Metabolic syndrome
IBD
High oxylate foods
Rhubarb Spinach Strawberries Chocolate Wheat bran/whole wheat products Nuts Beets Tea Turmeric
Uris acid is end product of
Purine metabolism
Uris acid stones that crystallize out of your blood and travel to toe or ankle cause
Gout
Uric acid stones are caused by
Part from endogenous source (tissue catabolism)
Part from diet
From super-saturation when pH of urine
Other risk factors for Uric acid stones
IBD - leads to acidic urine due to dehydration
Diabetes
Foods high in purines
Foods high in purines
Organ meats Anchovies Herrings Sardines Meat-based broth Gravies
Treatment for Uric acid stones
Extracorporeal shockwave lithotripsy (ECSWL)
Cysteine stones
From alkaline blood - treat with meds to balance pH and lots of fluid
Melamine stones
Drug that was in Chinese baby food and caused stones
Struvite stones
“Infection stones” from UTIs
Formed in presence of bacteria, breaks down urea to NH3 and CO2
Treat with antibiotics and responds to ECSWL
MNT for kidney stones
Lots of fluid (2.5 L) - 250 ml at every meal, between meals, during night, to avoid concentrated morning urine
High animal protein correlates with more stones
Ca intake should be normal, vit D intake should not be excess
Watch intake of oxylate foods, purine foods, Vit C, Vit B6
Treatment for Ca and oxylate stones
Have to pass them
Why care about kidney stones
Can damage kidney
Can block kidney and cause nitrogen wastes to build up, which can damage the brain
Risk factors for kidney stones
Diabetes
Obesity
Metabolic syndrome
IBD
High oxylate foods
Rhubarb Spinach Strawberries Chocolate Wheat bran/whole wheat products Nuts Beets Tea Turmeric
