Kidney Stones

Question 1

Why do renal stones occur?

Answer 1

Due to an imbalance between solutes and solution leading to a precipitation of the solutes out of solution

Question 2

What is the other name for kidney stones?

Answer 2

Nephrolithiasis

Question 3

Women are more commonly affected by kidney stones than men. T/F?

Answer 3

False - men are more commonly affected

Question 4

What is the composition of the majority of kidney stones?

Answer 4

Calcium

Question 5

What is the name for kidney stones which contain magnesium, ammonium and phosphate?

Answer 5

Struvite stones

Question 6

1-2% of kidney stones are composed of…?

Answer 6

Cysteine

Question 7

How common are uric acid kidney stones?

Answer 7

5-10% of all kidney stones

Question 8

How common are struvite kidney stones?

Answer 8

5-10% of all kidney stones

Question 9

What are the risk factors for nephrolithiasis?

Answer 9

BMI of over 27
Sedentary lifestyle
History of UTI
Caucasian race
Dehydration
positive family history of nephrolithiasis

Question 10

What type of diets have a protective role in the development of nephrolithiasis?

Answer 10

High fibre, high fruit diets

Question 11

What type of pain results from kidney stones?

Answer 11

Colicky pain from loin to groin

Question 12

What are the associated factors of pain from kidney stones?

Answer 12

Nausea

Vomiting

Question 13

What might be the findings of a renal examination of kidney stones?

Answer 13

Flank tenderness
Signs of infection
Obesity
Hypertension
Diabetes mellitus
Gouty tophi

Question 14

What conditions may cause nephrolithiasis?

Answer 14

Primary hyperparathyroidism
Hypercalcaemia
Hyperoxaluria
Hyperuricaemia
Cystinuria
Hypocitraturia
Renal tubular acidosis

Question 15

What type of kidney stones tend to develop at a pH of >7.0?

Answer 15

Calcium and struvite stones

Question 16

What type of stones tend to develop at a pH of <6.0?

Answer 16

Cysteine stones

Question 17

How would a kidney stone smaller than 2cm be managed?

Answer 17

Expectant management

extracorporeal shock wave lithotripsy

Question 18

How is a kidney stone, larger than 2cm managed?

Answer 18

Expectant management

Percutaneous ultrasound lithotripsy

Question 19

How much time should be allowed for small ureteral stone (<7mm) to pass by themselves?

Answer 19

2-4 weeks

Question 20

How can large ureteral stones be removed?

Answer 20

Uteroscopic stone fragmentation

Open surgery

Question 21

What is the advantage of using ureteral stents in the management of kidney stones?

Answer 21

These drain the obstructed kidney to alleviate pain
Dilate the ureter to facilitate passage of the stone
Facilitate the performance of uteroscopic procedures

Question 22

Preventative treatments, to prevent further stone formation can be given. What preventative treatments are given in the case of calcium phosphate stones?

Answer 22

Citrate

Thiazide if hypercalciruic

Question 23

Preventative treatments, to prevent further stone formation can be given. What preventative treatments are given in the case of calcium oxalate stones?

Answer 23

Citrate
Thiazide if hypercalciruric
Low oxalate diet

Question 24

Preventative treatments, to prevent further stone formation can be given. What preventative treatments are given in the case of uric acid stones?

Answer 24

Xanthine oxidase inhibitors (allopurinol / rasburicase)

alkalinised urine to >6.0

Question 25

Preventative treatments, to prevent further stone formation can be given. What preventative treatments are given in the case of cysteine stones?

Answer 25

Alkalinising urine to >7.0

Reduce protein and sodium in the diet

Question 26

Which type of kidney stone is commonly caused by infection?

Answer 26

Struvite stones

Question 27

How does citrate reduce urinary supersaturation of calcium?

Answer 27

By binding to calcium and forming soluble complexes which inhibit the growth of calcium crystals

Question 28

How can citrate inhibit the formation of irate and cysteine stones?

Answer 28

By having an alkalinising effect