Kidney Stones - Med Mgmt Flashcards
What history must you get from a patient with stone disease?
Medical conditions - high PTH, obesity, DM, RTA, gout, hyperthyrodism, malabsorption GI
Dietary - calcium, fruits and veggies, po liquid intake volume, animal protein, sodium intake
Medications - vit c, vit d, protease inhibitors, chemo, triamterene, carbonic anydrase inhibitors
What labs should you get?
UA, BMP, Ca, uric acid,
Which stones suggestive of metabolic issue?
Uric acid, cysteine, struvite
Which stone suggestive of medical condition or medication?
Calcium phosphate ( rta, pth, MSK)
What do we look for on 24 hour urine?
Urine volume, sodium, calcium, oxalate, citrate, magnesium, uric acid, ph, creatinine
What is recommendation on how much liquids to drink?
Whatever it takes to make 2.5L of UOP.
Dietary restrictions for calcium stone with high urinary calcium?
Limit sodium, maintain calcium
Dietary recs for caox stone + high urinary oxalate?
Limit oxalate, maintain Ca
Decrease vit C
Dietary recs for calcium stones with low urinary citrate?
Limit non dairy, animal protein, increase fruits and veggies
Dietary recs for uric acid or calcium stone, with high urinary uric acid?
Limit non dairy animal protein
Dietary recs for cystine stone?
Limit sodium and protein intake
Medical therapy for:
1. Recurrent stones + high urine CA
2. Recurrent ca stones + low urine citrate
3. Recurrent caox stones + high urine uric acid + normal Ca
4. Recurrent Ca stones
5. Uric acid and cysteine stones
6. Cystine stones
7. Residual or recurrent struvite stones
- Thiazide
- K cit
- Allopurinol
- Thiazide +/- k cit
- K cit
- A-mpg
- Acetohydroxamic acid (must make sure about cbc, for hemolytic anemia)W
What are different types of hypercalcuria?
absorptive (decrease oxalate, hydration, thiazides)
resorptive (surgery for parathyroid)
renal leak (thiazides)
