Nephrolithiasis

Question 1

Urease + (Protease, Klebsiella, S. Saphrophyticus)
organism cause UTI & Nephrolithiasis

What type/shape?

Answer 1

Ammonia, Mg, Phosphate (struvite)

Coffin (look like rectangles)

Question 2

Wedged shaped crystals

Answer 2

Calcium Phosphate

Question 3

Rhomboid/ Diamond/ Rosette crystals in urine

Answer 3

Uric Acid

Question 4

Unilateral Flank pain
Colicky pain

Hematuria

Answer 4

Nephrolithiasis

Question 5

Stones associated with Chron’s disease

Answer 5

Calcium oxalate

Question 6

Hydrochlorothiazide/Chlorothalidone (Thiazide diuretics) treats what Stones

Answer 6

Calcium oxalate/phosphate

Question 7

Calculi caused by infection with a urease positive organism

Microsopic shape

Answer 7

Ammonium, Magnesium, Phosphate (STRUVITE)

Microscopic: Coffin lid, rectangle studs

Question 8

Radiolucent kidney stone

seen in leukemia and myeloproliferative diseases

Answer 8

Uric acid

romboid/rosette/ parallelogram/ diamond shaped

Question 9

Hydrate and alkalanize urine with potassium bicarb to treat what stones

Answer 9

Uric Acid

*Allopurinol with Gou

Question 10

Hexagon shaped crystals
(+) urinary cyanide nitroprusside test

Answer 10

Cystine stones

Question 11

Forms rhomboid/rosette/ parallelogram/ diamond
or needle shaped
shaped crystals

Answer 11

Uric Acid

Question 12

Forms bioconcave/dumbbell/
envelope/stud/bipyramidal
shaped crystals

Answer 12

Calcium Oxalate stones

Question 13

Forms Wedged shaped/Prism

Answer 13

Calcium phosphate stones

Question 14

Forms Staghorn Calculi

Coffin lid crystals/ rectangle studs

Answer 14

Cysteinuria

Ammonium, Magnesium, Phosphate (STRUVITE)

Question 15

Ethylene glycol ingestion causes what kind of stones

Answer 15

calcium oxalate

Question 16

How to prevent/treat calcium oxalate stones?

Answer 16

Hydration
Thiazides
↑ Citrate (fruits & vegetables)
↑ Potassium
Urine alkalinization (citrate supplementation)
↓ Animal protein
↓ Sodium diet

Question 17

How to prevent/treat Uric Acid stones?

Answer 17

Hydration
Urine alkalinization (potassium citrate/biacarbonate)
Allopurinol
Low Purine Diet (Bacon, Liver, Deli Meats, Seafood)

Question 18

How to prevent/treat Cystine stones?

Answer 18

Urine alkalinization (citrate supplementation)
Low Sodium diet
Penicillamine (chelating)

Question 19

How to prevent/treat Struvite stones?

Answer 19

Abxs for UTI
Hydration
Urine Acidification (ammonium chloride)
Stone Removal

Question 20

How to prevent/treat Calcium Phosphate stones?

Answer 20

Hydration
Urine Acidification (ammonium chloride)
Thiazides
Low Sodium Diet

Question 21

Gout, hyperuricemia, &
High cell turnover (leukemia, chemotherapy)
cause what type of stones

Answer 21

Uric Acid Stones

Question 22

Radiolucent stones (seen on US)

Answer 22

Uric Acid

Question 23

Hyperparathyroidism
Type 1 renal tubular acidosis
cause what type of stones

Answer 23

Calcium Phosphate

Question 24

Hyper-calciuria
Hyper-oxaluria
Hypo-citraturia
Vitamin C Toxicity 
cause what type of stone

Answer 24

Calcium Oxalate

Question 25

Laboratory tests for Kidney stones:

1. Urine urinalysis
   Gross or microscopic ____
   pH> 7 suggests ____ stones
   pH< 5 indicates ___ stones
2. Urine Microscopy: to detect crystals

Answer 25

hematuria
urea-splitting organisms & struvite
uric acid

Question 26

___ or U/S are the tests of choice for diagnosis of nephrolithiasis.

Answer 26

NCCT scan

Question 27

Treatment depends on the size of the stone
< _ mm: often pass spontaneously

> _ mm: alpha-blocker (Tamsulosin) or CCB therapy.

> _ mm: often require shock wave lithotripsy or ureterorenoscopy

> _ mm: percutaneous nephrolithotomy

Answer 27

5
5
10
20

Question 28

Treatment depends on the size of the stone
< 5 mm: often pass spontaneously

> 5 mm: _____

> 10 mm: _____

> 20 mm: _____

Answer 28

alpha-blocker or CCB therapy

shock wave lithotripsy or ureterorenoscopy

percutaneous nephrolithotomy

Question 29

How to Prevent Calcium Oxalate stones?

Answer 29

↓ Oxalate (spinach)
Adequate calcium intake