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Kidney stones Flashcards

1
Q

Kidney stones can lead to severe complications such as

A
  1. hydronephrosis
  2. pyelonephritis
  3. SCC
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2
Q

Kidney stones - symptoms

A
  1. unilateral flank tenderness
  2. colicky pain
  3. pain radiating to groin
  4. hematuria (no casts)
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3
Q

Kidney stones - treat and prevent

A

encourage fluid intake

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4
Q

MC kidney stone presentation

A

calcium oxalate stone in patient with hypercalcemia or normocalcemia
Calcium stones MC (80%) –> calcium oxalate more common than calcium phosphate

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5
Q

Kidney stones - contain

A
  1. Caclium (calcium oxalate, caclicum phosphate)
  2. Ammonium magnesium phosphate
  3. Uric acid
  4. Cystine
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6
Q

kidney Caclium stones - types

A
  1. calcium oxalate

2. calcium phosphate

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7
Q

calcium oxalate vs calcium phosphate according to precipitation

A

calcium oxalate –> low pH

calcium phosphate –> high pH

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8
Q

calcium oxalate vs calcium phosphate according to x-ray findings

A

calcium oxalate –> radiopaque

calcium phosphate –> radiopaque

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9
Q

calcium oxalate vs calcium phosphate according to CT findings

A

calcium oxalate –> radiopaque

calcium phosphate –> radiopaque

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10
Q

calcium oxalate vs calcium phosphate according to urine crystals

A

calcium oxalate –> shape like envelope or dumbbell

calcium phosphate –> wedge-shaped prism

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11
Q

Calcium oxalate stones are precipitated by (beside low ph)

A
  1. ethylene glycol (antifreeze) ingestion
  2. vitamin C abuse
  3. malabsorption (Crohn disease)
  4. hypocitraturia –> low ph
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12
Q

kidney calcium stone treatment

A

calcium oxalate –> thiazides, citrate, low-sodium diet

calcium phosphate –> thiazides

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13
Q

Ammonium magnesium phosphate stones are precipitated by

A

high ph

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14
Q

Ammonium magnesium phosphate stones on CT and on X-ray

A

Radiopaque in both

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15
Q

Ammonium magnesium phosphate stones - urine cristal

A

coffin lid

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16
Q

Ammonium magnesium phosphate stones are AKA

A

sturvite

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17
Q

Ammonium magnesium phosphate stones (sturvite) (frequency)

A

15% of stones

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18
Q

Ammonium magnesium phosphate stone (sturvite) are caused by

A

infection with urease + bugs (eg. Proteus mirabilis, Staphylococcus saprophyticus, Klebsiella) that hydrolize urea to ammonia –> urina alkalization

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19
Q

Ammonium magnesium phosphate stone (sturvite) commonly form

A

staghorn calculi

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20
Q

staghorn calculi is a

A

large stone that takes up more than one branch of the collecting system in the renal pelvis of the kidney.

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21
Q

Ammonium magnesium phosphate stones (sturvite) - treatment

A
  1. eradication of underling infection

2. surgical removal of stone

22
Q

Urease + organisms

A
  1. proteus
  2. cryptococcus
  3. H. pyloru
  4. Ureoplasma
  5. Nocardia
  6. Klebsiella
  7. S. epidermidis
  8. S. saprophiticus
23
Q

Uric acid stones are precipitates in

24
Q

Uric acid stones on CT and on X-ray

A

X-ray –> radiolucent
CT –> minimally visible
BUT VISIBLE ON US

25
Uric acid stones - urine crystals
rhomboid or rosettes
26
Uric acid stones - frequency
5% of all stones
27
Uric acid stones - visible on
US
28
Uric acid stones - risk factors
1. low urine volume 2. arid climates 3. acidic ph 4. strong association with hyperuricemia
29
Uric acid stones - strong association with
hyperuricemia
30
Uric acid stones often seen in disease with
high turn over (eg. leukemia)
31
Uric acid stones - treatment
1. urine alkalization | 2. allopurinol
32
Cystine stones are precipitated by
low ph
33
Cystine stones on X-ray and CT
X-ray --> radiolucent | CT --> visible
34
Cystine stones - urine crystal
hexagonal
35
causes of Cystine stones
Hereditary (AR) condition in which Cystine -reabsorbing PCT transporter loses function causing cysteinuria (also poor reabsorption of ornithine, lysine, arginine) --> cystine is poorly soluble, thus stones form in urine (mneomnic: COLA: Cystine, Ornithine, Lysine, Arginine)
36
Cystine stones - age
usually begins in childhood
37
Cystine stones can form
staghorn calculi
38
Cystine stones - diagnosis
(+) sodium cyanide nitroprusside test
39
Cystine stones - treatment
1. low sodium diet 2. alkalinization of urine 3. chelating agents if refractory
40
kidney stones - types/precipitating factors/x-ray/CT
1. calcium oxalate --> low ph, radiopaque in both 2. caclicum phosphate --> high ph, radiopaque in both 3. Ammonium magnesium phosphate, high ph, radiopaque in both 4. Uric acid --> low ph, radiolucent in x-ray, minimally vissible in CT 5. Cystine --> low ph, radiolucent in xray, sometimes vissuble in CT
41
kidney stones - types and urine crystals
1. Calcium oxalate --> shaped like envelope or dumbbell 2. Caclicum phosphate --> wedge-shaped prism 3. Ammonium magnesium phosphate --> coffin lid 4. Uric acid --> Rhomboid or rosettes 5. Cystine --> hexagonal
42
Urinary incontinence - types
1. Stress incontinence 2. Urgency incontinence 3. Mixed incontinence 4. Overflow incontinence
43
urinary Stress incontinence - mechanism
Outlet incompetence (urethral hypermodility or intrinsic sphincteric deficiency --> leak with high intra-abdominal pressure (eg. sneezing, lifting)
44
urinary Stress incontinence - increased risk with
obesity vaginal delivery prostate surgery
45
urinary Stress incontinence - diagnosis
(+) bladder stress test --> directly observed leakage from urethral upon coughing or Valsvava maneuver)
46
urinary Stress incontinence - treatment
1. pelvic floor muscle strengthening (Kegel) exercise 2. weight loss 3. pessaries ( a plastic device inserted into the vagina)
47
urinary Urgency incontinence - mechanism
Overactive bladder (detrusor instability) --> leak with urge to void immediately
48
urinary Urgency incontinence - treatment
1. pelvic floor muscle strengthening (Kegel) exercise 2. bladder training (timed voiding, distraction and relaxation techniques) 3. antimuscarinics
49
urinary Mixed incontinence - mechanism
features of both stress and urgency incontinence
50
Overflow incontinence - mechanism
incomplete emptying (detrusor underactivity - weak to emoty the bladder or outlet obstruction) --> leak with overfilling --> increased postvoid residual (urinary retention) on cathetirization or ultrasound
51
Overflow incontinence - treatment
``` catherterization relieve obstruction (α-blockers for BPH) ```

Renal (15 decks)

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