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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
Almost without exception, staghorn stones are associated with an ___
upper UTI
26
Nucleation and attachment can occur on either ____, ____, ____, ____
renal epithelium cell surfaces bacteria aggregated/denatured proteins
27
What are the factors that influence calculi formation ?
``` supersaturation of chemical salts in urine absence of natural inhibitors urinary pH urine stasis nucleation and attachment ```
28
What is the organic matrix composed of the renal calculi ? made of lipids and proteins.
uromucoid
29
Majority of renal calculi cases contain ___ mixed with other components such as oxalate and/or phosphate
calcium
30
What is the characteristic of small calculi and where are they commonly found ?
sand and gravel upper urinary tract
31
What are compound stones characterized by ?
distinct concentric rings around a central nucleus
32
This stone composition precipitates at an acid or neutral pH and can occur at a frequency of 80%
calcium oxalate and/or calcium phosphate
33
This stone compositions forms calculi at normal urinary pH 6 - 6.5
calcium phosphate
34
This stone compositions crystallizes and forms calculi at low pH 5.3
uric acid
35
This stone composition forms calculi at alkaline pH
struvite
36
This stone composition results from adsorption of carbon dioxide by calcium phosphate crystals
carbonate
37
Dietary hypercalciuria is an uncommon cause of calcium stones associated with a large calcium intake, around ____g/day, together with a high protein shake
3-4g/day
38
This type of renal stones is most common and may form with excess oxalate and uric acid in the urine
calcium oxalate
39
Newly formed calcium oxalate aggregates are about _-_um in diameter
20-25um
40
calcium oxalate adherence to the ____ apparently allows stones to continue to grow rather than be excreted
epithelial surfaces
41
What are the characteristics of calcium oxalate stones ?
very hard often of a dark colour typically have a rough surface
42
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
calcium phosphate stones
43
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
calcium phosphate stones
44
What are the characteristics of calcium phosphate stones ?
pale and friable
45
Normally, an average adult excretes about ____mg or uric acid per day
500-600mg
46
What is the source of uric acid in which an average adult excretes per day ?
purine metabolism
47
Differentiate an insoluble and soluble uric acid
insoluble: pH 5.5 soluble: in the presence of sodium and potassium
48
What is the correlation of alkaline pH of urine and uric acid in urine in the formation of uric acid stones ?
more alkaline pH | amount of free uric acid decreases
49
This is known as an increase in uric acid in urine and predisposes an individual to developing uric acid stones
hyperuricuria
50
What are the characteristics of uric acid stones ?
yellow to brownish red | moderately hard
51
About 20% of patients with gout form stones, most of which are pure ___ or mixed ___ and ___
uric acid uric acid and calcium
52
What are some causes of hyperuricuria ?
excessive dietary intake of purines (liver, dried beans, some fish, meat) leukemias necrosis chemotherapy irradiation
53
This type of renal stone forms in patients with an inherited amino acid transport disorder
cystine stone
54
In the formation of cystine stones, ___, ___, ____, and ____, are subsequently excreted in large amounts in the urine but only ____ forms crystals and stones
cystine ornithine lysine arginine cystine
55
Differentiate the heterozygous and homozygous carriers for the amino acid transport disorder in relation to cystine stone formation
heterozygous carriers: increased amounts of cystine in urine but do not form stones homozygous carriers: stone formers
56
Cystine is soluble at a urine pH of ____
pH 7.4
57
What are the characteristics of cystine stone ?
yellow-brown | feels somewhat greasy
58
This is needed to detect the potential stone formers and should always be done when cystine crystals are found in random specimens
24-hour quantitative urine cystine measurement
59
What is the cause for renal calculi composed of silica ?
prolonged silica ingestion
60
What can help with identifying renal calculi composed of triamterene ?
1-2 mm mustard-coloured stones a bright blue fluorescence when dissolved in butanol and with exposure to UV light
61
What is the cause for renal calculi composed of adenine stones ?
inherited enzyme deficiency disorder and hyperuricemia
62
What is the cause for renal calculi composed of xanthine stones ?
associated with a genetic disorder with an absence of xanthine oxidase
63
___ and ___ prevents the supersaturation of solutes in urine and are therefore effective ways of preventing renal stone formation and growth
increasing fluid intake modifying dietary intake prevents
64
____ uses soundwaves to break up the renal stone in the body
extracorporeal shockwave lithotripsy
65
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
cytoscopy stent
66
If extracorporeal shockwave lithotripsy, cytoscopy, or using a stent doesn't work, what else can be performed ?
percutaneous nephrolithotomy
67
____ is when the formation of renal stones is most often discovered when the urinary tract becomes obstructed
hydronephrosis
68
Small stones can pass from the renal pelvis into the ureters, where they can cause obstruction and produce intense pain, often referred to as ____
renal colic
69
Intense pain produced by renal colic begins in the ____ and radiates forward and downward toward the ___, ___, or ____.
kidney region abdomen genitalia legs
70
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 ____
renal pelvis hematuria
71
____ is a constant finding when stones are present, even when they are asymptomatic
proteinuria
72
____ 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 ____
proteinuria B2 microglobulin albumin
73
How often are erythrocytes seen in routine urinalysis of renal stones ?
usually not found, and other casts are unusual
74
Multiple clusters of ____ cells may be found in the urine of patients with calculous disease
nonmalignant transitional
75
This specimen collection type may help detect supersaturation of solutes and reflect stone compositions
24-hour urine specimen
76
___ 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.
random urine sample three samples
77
____for calcium, phosphorus, uric acid, and electrolytes may also help identify patients predisposed to forming renal stones
serum chemistry
78
In the physical examination of renal stone analysis how is the washing process done ?
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
When cutting, sawing, or breaking the renal stone in the physical examination process what must be taken note of ?
whether there is a foreign body that may have acted as a nucleus for its formation
80
What is advised to do in the physical examination of very large renal stones ?
make separate analyses of layers that appear to have different constituents
81
What is the principle and result from the chemical examination of oxalates ?
Manganese oxide acts as an oxidizing agent in the production of carbon dioxide effervescence
82
What is the principle and result from the chemical examination of phosphates ?
Production of reduced oxides of molybdenum\ blue colour
83
What is the principle and result from the chemical examination of urates and uric acid ?
uric acid reduces orthophosphoric acid blue colour
84
What is the principle and result from the chemical examination of calcium ?
calcium ions in the presence of ammonium oxalate produces calcium oxalate precipitates white precipitate
85
What is the principle and result from the chemical examination of magnesium ?
formation of magnesium hydroxide in an alkaline solution that absorbs the azo dye in the reagent blue colour change and precipitate
86
What is the principle and result from the chemical examination of ammonium ?
Ammonia reacts with double iodide to form dimercuric ammonium iodide orange-brown precipitate
87
What is the principle and result from the chemical examination of cystine ?
proteins with free cysteine group yield a reddish colour with sodium nitroprusside in an ammoniacal solution beet-red colour
88
What are other methods of renal stone analysis ?
``` optical crystallography x-ray diffraction infrared spectroscopy electron beam analysis mass spectroscopy clinical chemistry methods ```

AUBF LEC (10 decks)

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