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AUA guidelines > Medical management of Stones > Flashcards

Medical management of Stones Flashcards

1
Q

What is the prevalence of nephrolithiasis?

A
  1. 8% overall
  2. 6% in men
  3. 1% in women
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2
Q

With health conditions are associated with nephrolithiasis?

A

Obesity
HTN
Diabetes

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3
Q

What diet has been shown to be potentially beneficial for recurrent stone forming men?

A

High fluid
Low sodium
Low animal protein
Normal Ca

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4
Q

What dietary factors may enhance stone formation?

A

Low calcium
Low fluid
Sugary drinks
High animal protein

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5
Q

What medical conditions should be asked about during evaluation of a stone patient?

A 
Obesity
Hyperthyroidism
Gout
RTA type I
Diabetes
Hyperparathyroidism
Bowel or pancreatic dz
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6
Q

What medications are associated with stone formation?

A 
Probenacid
Protease inhibitors
Lipase inhibitors
Triamterene
Chemotherapy
Vitamins C/D
Topiramate
Acetazolamide
Zonisamide
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7
Q

What laboratory workup should be included in the evaluation of a stone patient?

A

BMP
Ca
Uric acid
UA

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8
Q

What is the AUA guideline for a stone patient with high serum Ca?

A

PTH

Vit D

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9
Q

When should one suspect hyperparathyroidism in a Stone patient?

A

High serum Ca
CaP stones
Elevated urinary Ca

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10
Q

High Ca with normal mid range PTH?

A

Primary hyperparathyroidism

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11
Q

Potential causes of CaP stones?

A

RTA type 1
Primary hyperPTH
Medullary sponge
Carbonic anhydrase i

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12
Q

What can nephrocalcinosis indicate?

A

RTA type 1
Primary HyperPTH
Primary hyperoxaluria
Medullary sponge

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13
Q

When should a 24 urine analysis be obtained?

A

Recurrent stone formers
Interested first timers
High risk formers

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14
Q

What makes high risk stone formers?

A 
Family history
Solitary kidney
Intestinal malabsorption
rUTIs
Obesity/diabetes
Type 1 RTA
Primary hyperPTH
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15
Q

What are the AUA guidelines for metabolic testing for nephrolithiasis?

A

one or two 24-hour urine collections obtained on a random diet

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16
Q

What should a 24 hour urine analysis include at minimum?

A

Total volume, pH, calcium, oxalate, uric acid, citrate, sodium, potassium and creatinine.

17
Q

What are the roles of fasting calcium and calcium load testing?

A

They should not be used.

18
Q

What is the recommended daily fluid volume to prevent stones?

A

fluid intake that will achieve a urine volume of at least 2.5 liters daily

19
Q

What is the recommended calcium intake for stone formers?

A

Normal Ca intake
1000-1200 mg/day
Low Ca intake may lead to increased oxalate absorption.

20
Q

What is the recommended sodium intake for stone formers?

A

2300 mg/day

21
Q

What are the diet recommendations for Ca oxalate stones?

A

Limit oxalate rich foods and keep normal calcium consumption

22
Q

Calcium stone and lower urinary citrate diet recommendations?

A

increase fruits and vegetables. Limit non dairy animal protein.

23
Q

Uric acid/calcium stones with high uric acid diet recommendations?

A

Limit non dairy protein.

24
Q

Cysteine stones, diet recommendations?

A

Limit sodium and protein intake.

25
Q

Medical tx options for patient with high urine calcium and recurrent calcium stones?

A

HCTZ 25mg BID, 50mg qd
Chlorthalidone 25mg qd
Indapamide 2.5mg qd

26
Q

What additional medication may be needed when on thiazides?

A

Potassium supplementation.

27
Q

Tx for patient with recurrent calcium stones and low urinary citrate?

A

Clinicians should offer potassium citrate therapy to patients with recurrent calcium stones and low or relatively low urinary citrate.

28
Q

Medical treatment for a patient with recurrent calcium oxalate stones, hyperuricosuira, and normal urinary calcium?

A

Allopurinol

29
Q

What is the cutoff for hyperuricosuria?

A

> 800mg/day

30
Q

Medical treatment for a patient with recurrent calcium stones in which 24 hour urine analysis failed to identify an abnormality?

A

Thiazide diuretics

Potassium citrate

31
Q

What medical therapy is available for uric acid or cysteine stones?

A

Alkalinization of the urine with potassium citrate to 6 for uric acid and 7 for cysteine

32
Q

Role of allopurinol in uric acid stones?

A

Do not use as first line tx. Alkalinization is the first line treatment. Allopurinol can only be considered if patient continues to form uric acid stones on adequate alkaliniztion therapy.

33
Q

What is the first line medical therapy for Cysteine stones?

A

irst-line therapy for patients with cystine stones is increased fluid intake, restriction of sodium and protein intake, and urinary alkalinization.

34
Q

What are the second and third line treatments for Cysteine stones?

A

2nd line: Tiopronin

3rd line: d-penicillamine, captopril

35
Q

What is the medical treatment for patients with struvite stones that are recurrent and not treated adequately with surgical therapy?

A

acetohydroxamic acid (AHA), it is a urease inhibitor.

36
Q

What are the notable adverse effects of Acetohydroxamic acid?

A

Patients taking this medication should be closely monitored for phlebitis and hypercoagulable phenomena.

37
Q

How should patients on medical therapy for stones be followed up?

A

linicians should obtain a single 24-hour urine specimen for stone risk factors within six months of the initiation of treatment to assess response to dietary and/or medical therapy. Then annually thereafter. Blood testing should be tailored to specific medication.

AUA guidelines (7 decks)

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