Kidney stones and calcification

Question 1

What is the pathogenesis of kidney stone formation?

Answer 1

etiology remains unclear
urinary supersaturation and cyrstal retention at renal papilla are both key factors
associated risk factors

Question 2

What are the most common cause of kidney stones?

Answer 2

Caoxidized
Caphos
urates
infectious and strivite

Question 3

What is the epidemiology of kidney stones

Answer 3

lifetime 5-15%
men>women
white
regional variation

Question 4

What are drugst hat can form stones?

Answer 4

acyclovir
triamterene
sulfamethoxazole
indinavir

Question 5

Chronic kidney disease presents with what?

Answer 5

anemia
HTN
secondary hyperparathyroidism

metabolic acidosis
hyperkalemia
inability to maintain sodiumm and water balance
coagulopathy--platelet dysfunction
senorimotor neuropathy

Question 6

What are the physical symptoms of chronic uremia?

Answer 6

lethargy, fatigue
day-night reversal
pruritis
anorexia, nausea
restless legs syndrome
uremic pericarditis

Question 7

How do you slow progression of CKD?

Answer 7

control HTN
reduce proteinuria
control blood sugar
smoking cessation
disease-specific therapy

Question 8

What are the risk factors of kidney stones?

Answer 8

previous renal disease
IBD/short gut
hyperparathyroidism
hypercalcemia
gout 
HIV
FamHx
dehydration

Question 9

What are the dietary risk factors of kidney stones?

Answer 9

low fluid intake
high salt intake
high protein intake
low calcium intake
high oxalate intake

Question 10

What genetic disease cause stones?

Answer 10

cystinuria
primary hyperoxalosis
dent disease
familial hypomagnesemai with hypercalcemia
adenosine phosphoribosyltransferase
distal renal tubular acidosis

Question 11

What is primary hyperoxalosis/hyperoxaluria

Answer 11

rare genetic disorder of liver enzyme leading to excessive endogenous oxalate synthesis

Question 12

How does presentation of kidney stones?

Answer 12

ROS

• renal colic
• hematuria
• fever
• nausea
• urinary frequency
• passed stone

PE

• distress
• mild to moderate
• fever
• hematuria
• elevated WBCs
• elevated serum creatinine

Question 13

How is a kidney stone diagnosed?

Answer 13

CT scan

ultrasound

Question 14

What is the treatmetnt of kidney stone?

Answer 14

acute disease
-removal of stone
-symptom control
Chronic disease
-metabolic activation
-meds
-surgery

Question 15

What are the chronic treatments of cystine stone?

Answer 15

dilution
alkalinize urine
cystein binding drugs (disulfide exchange)

Question 16

What is the chronic treatment of uric acid stones?

Answer 16

dilution
low protein/high fruit diet
alkalinize urine
xanthine oxidase inhibitors

Question 17

What is the chronic treatment of struvite?

Answer 17

dilution
sterilize urine -eliminate urea splitting bacteria
remove residula stone material
adjunctive therapies

Question 18

What chronic treatments for calcium stones?

Answer 18

diliution
maintain normal calcium intake
reduce urine calcium excretion
-limit Na+ and protein in diet
-add thiazide diuretics
reduce urine oxalate
-add calcium and or limit oxalate
add pyridoxine
increase urine citrate