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Renal > Kidney stones > Flashcards

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
Q

Uric acid stones - urine crystals

A

rhomboid or rosettes

26
Q

Uric acid stones - frequency

A

5% of all stones

27
Q

Uric acid stones - visible on

28
Q

Uric acid stones - risk factors

A
  1. low urine volume
  2. arid climates
  3. acidic ph
  4. strong association with hyperuricemia
29
Q

Uric acid stones - strong association with

A

hyperuricemia

30
Q

Uric acid stones often seen in disease with

A

high turn over (eg. leukemia)

31
Q

Uric acid stones - treatment

A
  1. urine alkalization

2. allopurinol

32
Q

Cystine stones are precipitated by

33
Q

Cystine stones on X-ray and CT

A

X-ray –> radiolucent

CT –> visible

34
Q

Cystine stones - urine crystal

35
Q

causes of Cystine stones

A

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
Q

Cystine stones - age

A

usually begins in childhood

37
Q

Cystine stones can form

A

staghorn calculi

38
Q

Cystine stones - diagnosis

A

(+) sodium cyanide nitroprusside test

39
Q

Cystine stones - treatment

A
  1. low sodium diet
  2. alkalinization of urine
  3. chelating agents if refractory
40
Q

kidney stones - types/precipitating factors/x-ray/CT

A
  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
Q

kidney stones - types and urine crystals

A
  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
Q

Urinary incontinence - types

A
  1. Stress incontinence
  2. Urgency incontinence
  3. Mixed incontinence
  4. Overflow incontinence
43
Q

urinary Stress incontinence - mechanism

A

Outlet incompetence (urethral hypermodility or intrinsic sphincteric deficiency –> leak with high intra-abdominal pressure (eg. sneezing, lifting)

44
Q

urinary Stress incontinence - increased risk with

A

obesity
vaginal delivery
prostate surgery

45
Q

urinary Stress incontinence - diagnosis

A

(+) bladder stress test –> directly observed leakage from urethral upon coughing or Valsvava maneuver)

46
Q

urinary Stress incontinence - treatment

A
  1. pelvic floor muscle strengthening (Kegel) exercise
  2. weight loss
  3. pessaries ( a plastic device inserted into the vagina)
47
Q

urinary Urgency incontinence - mechanism

A

Overactive bladder (detrusor instability) –> leak with urge to void immediately

48
Q

urinary Urgency incontinence - treatment

A
  1. pelvic floor muscle strengthening (Kegel) exercise
  2. bladder training (timed voiding, distraction and relaxation techniques)
  3. antimuscarinics
49
Q

urinary Mixed incontinence - mechanism

A

features of both stress and urgency incontinence

50
Q

Overflow incontinence - mechanism

A

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
Q

Overflow incontinence - treatment

A 
catherterization
relieve obstruction (α-blockers for BPH)

Renal (15 decks)

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