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Nephrology > Nephrolithiasis > Flashcards

Nephrolithiasis Flashcards

1
Q

dietary factors that lead to nephrolithiasis

A

low fluid intake, calcium, K

high oxalate, protein, Na, sugar drinks

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2
Q

Inhibitors of stone formation

A

magnesium, citrate, pyrophosphate, THprotein

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3
Q

inhibits caox crystal formation and growth binding with oxalate

A

Magnesium

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4
Q

retards the crystal growth of CaP and CaOx crystals by binding to the surface of basic CaP crystals

A

pyrophosphate

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5
Q

chelates calcium, reduced calcium binding calcium with Ox and P

A

Citrate

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6
Q

acts as both promoter and inhibitor of stone formation

A

THProtein

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7
Q

metabolic processes that induce ca stone formation

A

Increase urine ca > 4 mkd, 250-300 mg/day; Urine Uric acid > 800 mg/day, urine oxalate > 45 mg/d, Dec Ucitratee < 320 mg/day; alterations in urine ph

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8
Q

most common metabolic abnormality in ca stone formation

A

absorptive hypercalciuria

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9
Q

most common cause of resoprtive hypercalciuria

A

primary hyperparathyroidism

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10
Q

highest source of uric acid

A

de novo synthesis

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11
Q

clinical conditions with hypocitraturia

A

overproduction acidosis, underexcretion acidosis
K deficiency
excess dietary protein

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12
Q

autosomal recessive condition in childhood with CaOx stones and nephrocalcinosis, frequent stone recurrence

A

primary hyperoxaluria

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13
Q

inflammatory bowel disease, jejunoileal bypass, bariatric surgery for morbid obesity

A

enteric hyperoxaluria

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14
Q

predispose to hyperuricosuric ca oxalate lithiasis

A

highly acidic urine (pH < 5.5)

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15
Q

predispose to caphos lithiasis

A

alkaline urine (pH > 6.7)

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16
Q

most impt in uric acid stones

A

low urine pH

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17
Q

main cause of idiopathic uric acid urolithiasis

A

low urine pH

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18
Q

patients with gouty arthritis and kidney stones, UA > 10 md/d, urine ua > 1000 mg/day

A

hyperuricosuria

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19
Q

Increases saturation of all stone forming elements

A

low urine volume

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20
Q

Pathophysio of uric acid stones

A

Low urine pH, volume

Hyperuricosuria

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21
Q

genetic disease caused by inactivating mutations of the subunits of a dibasic aminoacid transporter in then proximal tubule

A

cystinuria

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22
Q

most common primary inherited aminoaciduria

A

cystinuria

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23
Q

family hx of cystinuria (> 400 mg/day vs 30 mg), staghorn calculi, hexagonal crystals on urinalysis

A

cystinuria

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24
Q

most prevalent component of kidney stones

A

calcium oxalate

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25
most likely cause of nephrolithiasis in a patient with distal RTA
hypocitraturia
26
depressions near the papillary tips, yellow crystalline deposits in the ducts of bellini, some randall plaques
Calcium phosphate
27
1st kidney stone work up
medical hx, stone analysis, urine analysis
28
Recurrent kidney stone
full metabolic evaluation - serum panel, PTH, VitD if hyperCa, 24ag urine >= 2 samples Na Ca Oxalate Uric acid citrate
29
indicative of minimal fluid intake
urine volume less than 2.5L
30
pH with increase risk of uric acid precipitation, idiopathic uric acid stone, intestinal disease and diarrhea and intestinal bypass surgery
less than 5.5
31
Increase risk of caphos precipitation, dRTa, primary hyperparathyroidism, alkali, ca tx
pH > 6.7
32
pH that indicates urinary tract infection fom urease producing bacteria
> 7-7.5
33
Normal UCrea
F: 15-20 mk M: 20-25 mk
34
reflects dietary Na and K intake
24H urine Na and K
35
Major cause of hypercalciuria
High Na intake
36
Normal Urine Na K Ca
Na 100 K 40-60 Ca < 250-300 mg
37
Low Mg increases risk of
calcium stones | UMg <30-120 mg
38
UOxalate > 100 mg/day
primary hyperoxaluria
39
Higher Uphos > 1100 mg
calcium phosphate formation
40
hyperuricosuria, Uuric acid > 600-800
CaOx stones Uph > 5.5 | Uric acid stones UpH <5.5
41
marker of dietary acid intake
sulfate
42
high ammonium/sulfate ratio
GI alkali loss
43
Normal Urine NH4
30-40 meq
44
Petsistent high Uca on a restricted diet
intestinal hyperabsorption of Ca
45
Elevated fasting Ca/Crea (0.11 mg/100 ml or <2.7 umil/100 mg), high serum calcium, elevated pth
primary hyperparathyroidism
46
Elevated Ca/Crea, normal serum Ca, normal or suppressed PTH
resoprtive hypercalciuria
47
elevated Ca/Cr, normal Ca, elevated pth
Renal hypercalciuria
48
Elevated Ca/Cr (0.2 mg/mg or 0.56 mmol/mmol) 4h Ca/Crea after 1 g oral load
absorptive hypercalciuria
49
dumbless shaped crystals
calcium oxalate monohydrate
50
Envelope shaped crystals
calcium oxalate dihydrate
51
Flat shaped or wedge shaped prisms, often in rosettes
Calcium phosphate
52
Gold standard for kidney stone diagnosis
noncontrast ct un enhanced ct scan ct stonogram
53
time when surgical intervention is indicated
4 weeks
54
average days of stone passage
40 days
55
medical expulsive therapy
ccb, steroids, a-blockers
56
target fluid intake
Urine volume > 2.5L | cystinuria > 4L water intake
57
Dietary mgt
``` Na < 100 meq/day animal protein 50-60 g/day Ca 1000-1200 mg avoid > 1g Vit C Fruits/vegetables ```
58
Drug of choice hypercalciuria in caOx and Caphos stone formers
Thiazides 25 bid
59
Tx hypocitraturia in caox and caphos, uric acid stones, cystine stones
20-80 meqs 3-4 doses | uric acid: pH goal > 6, cysteine pH > 7,
60
Treatment Ca stone formers with hyperuricosuria
Allopurinol 100-300 mg/d
61
cystine stones
penicillamine
62
Struvite stones when other interventions have failed
acetohydroxamic acid 15 mkd
63
first line therapy for uric acid stone formers
Urine alkalinization
64
tx of choice struvite stones, impacted stone; largest stone free rate and less recurrenfe rate
percutaneous nephrolithotomy
65
hexagonal stones- tx
Cystine, tiopronin
66
coffin lid like
struvite
67
uric acid stones are
pleomorphic

Nephrology (28 decks)

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