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AUBF LEC > M5U2: RENAL CALCULI > Flashcards

M5U2: RENAL CALCULI Flashcards

1
Q

These are aggregates of mineral salts interlaid with a matrix of protein and lipids

A

Calculi

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2
Q

Calculi may form in secretory organs of the body such as ?

A 
pancreas
gall bladder
salivary gland
lacrimal gland
urinary tract
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3
Q

In the urinary system, calculi are normally commonly found in the ___

A

renal calyces
pelvis
ureter
bladder

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4
Q

In healthy individuals, crystals are normally ___um in size

A

<20um

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5
Q

In renal calculi formation, this stage consists of the metastable zone

A

Crystal growth

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6
Q

In renal calculi formation, this stage consists of the unstable zone: homogenous nucleation

A

Nucleation

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7
Q

What is the steps of renal calculi formation ?

A

Supersaturation -> Nucleation -> Crystal growth -> Aggregation -> Stone formation

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8
Q

What are the external causes that lead to the supersaturation of solutes in urine include ?

A

dehydration
diet (increase in urinary oxalate is observed among vegetarians)
increased intestinal absorption
medications

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9
Q

Endocrine disorders such as ____ results to an increase in the reabsorption of calcium from the bone

A

hyperparathyroidism

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10
Q

This is an increase in concentration of calcium in the plasma

A

hypercalcemia

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11
Q

This is an increase in concentration of calcium in urine

A

hypercalciuria

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12
Q

These metabolic conditions that cause the accumulation of solutes in blood would also cause an increase in urine, these are ?

A

gout (hyperuricemia)
cystinosis (cystinuria)
primary hyperoxaluria

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13
Q

Patients with ____ have an increased risk of developing renal calculi

A

hypercalciuria
hyperoxaluria
hyperuricemia

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14
Q

The absence of these which normally prevents crystal aggregation, nucleation and adherence allows renal stone formation

A

natural inhibitors

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15
Q

Some of the identified natural inhibitors include ?

A 
naphrocalcin
osteopontin (uropontin)
citrate
Tamm-Horsfall protein (uromodulin)
prothrombin F1 fragment
heparan sulfate
pyrophosphate
CD59.8,9
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16
Q

Why is the acid-alkaline tide important ?

A

prevents the formation or growth of renal stones

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17
Q

What would happen to a patient that may show signs of isohyduria ?

A

urine pH of the patient remains constant and therefore enhances crystal and stone formation

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18
Q

___ is a metabolic condition wherein the tubules fail to secrete hydrogen ions and increases calcium excretion to compensate

A

renal tubular acidosis

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19
Q

These are examples of urea-splitting organisms

A

Proteus spp.
Pseudomonas spp
Enterococcus spp

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20
Q

How can the urea-splitting organisms make urine alkaline ?

A

organisms convert urea to ammonia

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21
Q

Patients with UTI caused by urea-splitting organisms tend to form ____ stones

A

magnesium stones
ammonium stones
phosphate stones
struvite stones

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22
Q

Magnesium ammonium phosphate and struvite stones can cause

A

bleeding (hematuria)
obstruction
infection without stone passage

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23
Q

When stones in the renal pelvis become so large they extend into two or more calyces, they are called ___

A

staghorn stones

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24
Q

Where can staghorn stones be found in ?

A

renal pelvis

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25
Q

Almost without exception, staghorn stones are associated with an ___

A

upper UTI

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26
Q

Nucleation and attachment can occur on either ____, ____, ____, ____

A

renal epithelium
cell surfaces
bacteria
aggregated/denatured proteins

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27
Q

What are the factors that influence calculi formation ?

A 
supersaturation of chemical salts in urine
absence of natural inhibitors
urinary pH
urine stasis
nucleation and attachment
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28
Q

What is the organic matrix composed of the renal calculi ? made of lipids and proteins.

A

uromucoid

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29
Q

Majority of renal calculi cases contain ___ mixed with other components such as oxalate and/or phosphate

A

calcium

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30
Q

What is the characteristic of small calculi and where are they commonly found ?

A

sand and gravel

upper urinary tract

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31
Q

What are compound stones characterized by ?

A

distinct concentric rings around a central nucleus

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32
Q

This stone composition precipitates at an acid or neutral pH and can occur at a frequency of 80%

A

calcium oxalate and/or calcium phosphate

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33
Q

This stone compositions forms calculi at normal urinary pH 6 - 6.5

A

calcium phosphate

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34
Q

This stone compositions crystallizes and forms calculi at low pH 5.3

A

uric acid

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35
Q

This stone composition forms calculi at alkaline pH

A

struvite

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36
Q

This stone composition results from adsorption of carbon dioxide by calcium phosphate crystals

A

carbonate

37
Q

Dietary hypercalciuria is an uncommon cause of calcium stones associated with a large calcium intake, around ____g/day, together with a high protein shake

A

3-4g/day

38
Q

This type of renal stones is most common and may form with excess oxalate and uric acid in the urine

A

calcium oxalate

39
Q

Newly formed calcium oxalate aggregates are about _-_um in diameter

A

20-25um

40
Q

calcium oxalate adherence to the ____ apparently allows stones to continue to grow rather than be excreted

A

epithelial surfaces

41
Q

What are the characteristics of calcium oxalate stones ?

A

very hard
often of a dark colour
typically have a rough surface

42
Q

This type of renal stones’ formation is favored by a less acid urine as seen in renal tubular acidosis, with infection, and in persons consuming large amounts of alkali

A

calcium phosphate stones

43
Q

Other than this being commonly observed in patients with primary hyperparathyroidism, patients exposed to heat and dehydration may contribute to the formation of this stone

A

calcium phosphate stones

44
Q

What are the characteristics of calcium phosphate stones ?

A

pale and friable

45
Q

Normally, an average adult excretes about ____mg or uric acid per day

A

500-600mg

46
Q

What is the source of uric acid in which an average adult excretes per day ?

A

purine metabolism

47
Q

Differentiate an insoluble and soluble uric acid

A

insoluble: pH 5.5
soluble: in the presence of sodium and potassium

48
Q

What is the correlation of alkaline pH of urine and uric acid in urine in the formation of uric acid stones ?

A

more alkaline pH

amount of free uric acid decreases

49
Q

This is known as an increase in uric acid in urine and predisposes an individual to developing uric acid stones

A

hyperuricuria

50
Q

What are the characteristics of uric acid stones ?

A

yellow to brownish red

moderately hard

51
Q

About 20% of patients with gout form stones, most of which are pure ___ or mixed ___ and ___

A

uric acid

uric acid and calcium

52
Q

What are some causes of hyperuricuria ?

A

excessive dietary intake of purines (liver, dried beans, some fish, meat)
leukemias
necrosis chemotherapy
irradiation

53
Q

This type of renal stone forms in patients with an inherited amino acid transport disorder

A

cystine stone

54
Q

In the formation of cystine stones, ___, ___, ____, and ____, are subsequently excreted in large amounts in the urine but only ____ forms crystals and stones

A

cystine
ornithine
lysine
arginine

cystine

55
Q

Differentiate the heterozygous and homozygous carriers for the amino acid transport disorder in relation to cystine stone formation

A

heterozygous carriers: increased amounts of cystine in urine but do not form stones

homozygous carriers: stone formers

56
Q

Cystine is soluble at a urine pH of ____

A

pH 7.4

57
Q

What are the characteristics of cystine stone ?

A

yellow-brown

feels somewhat greasy

58
Q

This is needed to detect the potential stone formers and should always be done when cystine crystals are found in random specimens

A

24-hour quantitative urine cystine measurement

59
Q

What is the cause for renal calculi composed of silica ?

A

prolonged silica ingestion

60
Q

What can help with identifying renal calculi composed of triamterene ?

A

1-2 mm mustard-coloured stones

a bright blue fluorescence when dissolved in butanol and with exposure to UV light

61
Q

What is the cause for renal calculi composed of adenine stones ?

A

inherited enzyme deficiency disorder and hyperuricemia

62
Q

What is the cause for renal calculi composed of xanthine stones ?

A

associated with a genetic disorder with an absence of xanthine oxidase

63
Q

___ and ___ prevents the supersaturation of solutes in urine and are therefore effective ways of preventing renal stone formation and growth

A

increasing fluid intake

modifying dietary intake prevents

64
Q

____ uses soundwaves to break up the renal stone in the body

A

extracorporeal shockwave lithotripsy

65
Q

If the stone is found in the lower third of the ureter or in the bladder ___ can be used to remove the stone or to place a ____ for drainage

A

cytoscopy

stent

66
Q

If extracorporeal shockwave lithotripsy, cytoscopy, or using a stent doesn’t work, what else can be performed ?

A

percutaneous nephrolithotomy

67
Q

____ is when the formation of renal stones is most often discovered when the urinary tract becomes obstructed

A

hydronephrosis

68
Q

Small stones can pass from the renal pelvis into the ureters, where they can cause obstruction and produce intense pain, often referred to as ____

A

renal colic

69
Q

Intense pain produced by renal colic begins in the ____ and radiates forward and downward toward the ___, ___, or ____.

A

kidney region

abdomen
genitalia
legs

70
Q

Large stones are unable to pass into the ureter and remains in the ___ and are revealed because of the trauma they produce, which usually occurs as ____

A

renal pelvis

hematuria

71
Q

____ is a constant finding when stones are present, even when they are asymptomatic

A

proteinuria

72
Q

____ is usually not a feature of calculous disease, but with renal tubular damage there may be increased excretion of low-molecular-weight plasma proteins such as ____, and some ____

A

proteinuria

B2 microglobulin
albumin

73
Q

How often are erythrocytes seen in routine urinalysis of renal stones ?

A

usually not found, and other casts are unusual

74
Q

Multiple clusters of ____ cells may be found in the urine of patients with calculous disease

A

nonmalignant transitional

75
Q

This specimen collection type may help detect supersaturation of solutes and reflect stone compositions

A

24-hour urine specimen

76
Q

___ is a sufficient specimen collection method for the metabolic evaluation of stone formers, although due to day-to-day variation, ____ should be obtained to overcome the doubtful significance of a single result.

A

random urine sample

three samples

77
Q

____for calcium, phosphorus, uric acid, and electrolytes may also help identify patients predisposed to forming renal stones

A

serum chemistry

78
Q

In the physical examination of renal stone analysis how is the washing process done ?

A

stones are washed free of blood, mucus, preservation solution

place stones in a beaker, cover with several thicknesses of gauze held firmly with rubber bands, and wash under cold running water

drain, remove gauze carefully, and dry beaker and stones in an oven

rinse tiny stones with water from a squeeze bottle and not running water

79
Q

When cutting, sawing, or breaking the renal stone in the physical examination process what must be taken note of ?

A

whether there is a foreign body that may have acted as a nucleus for its formation

80
Q

What is advised to do in the physical examination of very large renal stones ?

A

make separate analyses of layers that appear to have different constituents

81
Q

What is the principle and result from the chemical examination of oxalates ?

A

Manganese oxide acts as an oxidizing agent in the production of carbon dioxide

effervescence

82
Q

What is the principle and result from the chemical examination of phosphates ?

A

Production of reduced oxides of molybdenum\

blue colour

83
Q

What is the principle and result from the chemical examination of urates and uric acid ?

A

uric acid reduces orthophosphoric acid

blue colour

84
Q

What is the principle and result from the chemical examination of calcium ?

A

calcium ions in the presence of ammonium oxalate produces calcium oxalate precipitates

white precipitate

85
Q

What is the principle and result from the chemical examination of magnesium ?

A

formation of magnesium hydroxide in an alkaline solution that absorbs the azo dye in the reagent

blue colour change and precipitate

86
Q

What is the principle and result from the chemical examination of ammonium ?

A

Ammonia reacts with double iodide to form dimercuric ammonium iodide

orange-brown precipitate

87
Q

What is the principle and result from the chemical examination of cystine ?

A

proteins with free cysteine group yield a reddish colour with sodium nitroprusside in an ammoniacal solution

beet-red colour

88
Q

What are other methods of renal stone analysis ?

A 
optical crystallography
x-ray diffraction
infrared spectroscopy
electron beam analysis
mass spectroscopy
clinical chemistry methods

AUBF LEC (10 decks)

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