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Renal > Kidney Stones > Flashcards

Kidney Stones Flashcards

1
Q

What general chemistry principle causes kidney stones?

A

super saturation concentration > specific ion solubility threshold = precipitate

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2
Q

What is a “nidi’ for stone formation? why is this important?

A

a point of organization for formation of a stone - since urine is not pure water, the other solutes can affect the solubility of the ion in question and encourage it’s precipitation

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3
Q

How does supersaturation affect our therapeutics for kidney stones?

A
  1. increase solubility (via changing pH, for example) 2. decrease saturation (decrease ion concentration relative to water in urine)
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4
Q

What are the 4 kinds of kidney stones?

A
  1. calcium 2. struvite 3. uric acid 4. cysteine
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5
Q

What are the 2 types of calcium containing stones?

A

calcium oxalate (most common) and calcium phosphate

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6
Q

What’s the most common kind of kidney stone?

A

calcium containing

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7
Q

What are 2 specific risk factors for calcium kidney stones?

A
  1. hypercalciuria 2. hyperoxaluria
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8
Q

What cause hypercalciuria, which is a risk factor for calcium containing kidney stones?

A
  1. systemic hypercalcemia (i.e. primary hyperparathryoidism, vitamin D toxicity, etc) 2. idiopathic increase in serum calcium
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9
Q

Primary hyperparathyroidism, vitamin D toxicity, malignancy and sarcoidosis are all risk factors for what kind of kidney stone?

A

calcium containing stones secondary to systemic hypercalcemia

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10
Q

Chocolate, spinach, berries and nuts all contain what substance that contributes to kidney stones?

A

oxalate

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11
Q

What effect does excessive vitamin C intake have on kidney stone risk?

A

it increases oxalate absorption, increasing risk of calcium oxalate stones

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12
Q

What effect doe malabsorptive conditions have on kidney stone risk?

A

they increase oxalate absorption (which is confusing) examples: celiacs, crohn’s, gastric bypass

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13
Q

What is primary hyperoxalosis?

A

a rare genetic condition that causes elevated oxalate levels and leads to calcium oxalate kidney stones

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14
Q

Why are struvite stones also called “infection” stones?

A

they are caused by urease producing bacteria in the urine (ie. proteus )

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15
Q

What are the 2 components of struvites stones?

A

magnesium ammonium phosphate and calcium carbonate apatite

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16
Q

what is the second most common kind of kidney stone in the US?

A

struvite stones

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17
Q

How do proteus infections cause struvite stones?

A

Require presence of urease-producing bacteria in the urine -> leads to rise in urine pH, becoming quite alkaline -> urinary phosphate becomes insoluble and forms stones with surrounding magnesium, ammonium and calcium

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18
Q

What pH is a risk factor for struvite stones?

A

alkaline (high pH)

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19
Q

What are staghorn calculi? when are they most common?

A

kidney stones that penetrate more than one renal calyx, most common with struvite stones (especially with proteus infections)

20
Q

What causes uric acid stones?

A

hyperuricosuria due to high purine/protein intake or states of cell turnover and breakdown

21
Q

What kind of kidney stones are chemotherapy, myeloproliferative disorders, or hemolytic anemia a risk factor for?

A

uric acid stones - cell lysis releases uric acid into the body and leads to hyperuricosuria

22
Q

What pH is required for formation of uric acid stones?

A

acidic (less than 5.5)

23
Q

Are uric acid stones radiopaque or radiolucent on x ray?

A

radiolucent - you cannot see them, unlike with calcium containing stones

24
Q

What are some general risk factors for kidney stone formation?

A

low urine volume high sodium diet high protein diet hypocitrauria

25
Q

why does low urine volume increase risk of kidney stones?

A

it increases concentrations of all substances, increasing the likelihood that saturation thresholds will be passed

26
Q

why would high sodium diets cause kidney stones?

A

high sodium diets would decrease calcium reabsorption, which would increase UCa and make Ca more likely to precipitate

27
Q

Why would a high protein diet cause kidney stones?

A

increases acid load on the body, which is buffered by Ca release from bone, elevating serum and urine calcium. Also decreases citrate levels in urine, which is a major cause of kidney stones

28
Q

why would hypocitrauria cause kidney stones?

A

citrate inhibits stone formation by binding calcium

29
Q

What are some causes of low urinary citrate?

A

excessive protein intake, metabolic acidosis, hypokalemia etc for exposure

30
Q

What is “renal colic”?

A

a presentation of kidney stones that is acute pain in the flank, back or abdomen that radiates to the groin

31
Q

What is seen (grossly or microscopically) in the clinical presentation of kidney stones?

A

hematuria - may not be gross enough to be noted by the patient

32
Q

What are the steps for evaluating a kidney stone?

A
  1. urinalysis (hematuria and infection) 2. imaging
33
Q

What is the gold standard imaging test for kidney stones?

A

non contrast abdomen CT

34
Q

If you use an xray to look for kidney stones, what might you miss?

A

uric acid stones

35
Q

What are the treatments for kidney stones?

A
  1. pain control and fluids 2. if larger than 5 mm, lithotripsy can break up the stones
36
Q

What are the long term management steps for kidney stones?

A
  1. stone analysis to evaluate RF 2. 24 hour urine collection 3. medication adjustment (loop diuretics, calcium supplements, etc should be discontinued or decreased)
37
Q

Should you recommend a low calcium diet to a patient with calcium containing kidney stones?

A

no! low calcium diets are bad for your bones and do not affect your risk of kidney stone formation

38
Q

What supplements should be added for kidney stone patients?

A

citrate supplements (potassium citrate)

39
Q

What diuretic should be stopped for kidney stones? what should be added?

A

loop diuretics - increase hypercalciuria thiazides - decrease hypercalciuria

40
Q

A 45-year-old Caucasian male with a history of chronic myeloid leukemia for which he is receiving chemotherapy presents to the emergency room with oliguria and colicky left flank pain. His serum creatinine is 3.0 mg/dL and is urine pH is 5.0. You diagnose nephrolithiasis. His kidney stones, however, are not visible on abdominal x-ray. His stone is most likely composed of which of the following? a. Calcium oxalate b. Struvite c. Uric acid d. Cysteine

A

c - uric acid

41
Q

A 30-year-old male with history of two prior episodes of nephrolithiasis presents to establish care in your clinic. He would like to discuss strategies to prevent future kidney stones. He has not had analysis done of his prior kidney stones. You order a 24-hour urine collection for Ca, Na, phosphorus, uric acid, and citrate. Before even obtaining results, which of the following would be an appropriate recommendation? a. Increase dietary sodium intake b. Increase dietary protein intake c. Lower dietary calcium intake d. Increase fluid intake to target urine volume of >2L per day

A

d - increase fluid intake to a target urine volume of > 2 L per day

42
Q

What kind of kidney stone is this?

A

calcium oxalate - “square envelopes”

43
Q

What kind of kidney stone is this?

A

Uric acid - diamond/rhomboid shape

** less reliable with uric acid stones than other types

44
Q

What kind of kidney stone is this?

A

Struvite - “coffin lids”

45
Q

What kind of kidney stone is this?

A

cysteine - hexagonal

pathomneumonic - if it’s in this shape, it is definitely cysteine

46
Q

What pH level can increase risk of cysteine stones?

A

low pH - treatment should alkalinize urine

Renal (28 decks)

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