Nephrolithiasis

Question 1

Factors that determine how DESTRUCTIVE a urinary obstruction is

Answer 1

1. Degree (partial or total)
2. Location
3. Duration (acute or chronic)
4. Timing (more time, more damage)

Question 2

Where can a Urinary Obstruction occur?

Answer 2

Renal Pelvis
Ureter
Bladder and Urethra

Question 3

Causes of Obstructions: Renal Pelvis

Answer 3

Calculi or Stone

Question 4

Causes of Obstructions: Ureter

Answer 4

Renal Calculi (movement causes pain)
Pregnancy (fetus)
Tumors

Question 5

Causes of Obstructions: Bladder and Urethra

Answer 5

Bladder Cancer
Neurogenic Bladder
Prostatic Hyperplasia
Prostate Cancer
Urethral Strictures (Catheter)

Question 6

Complications of Obstruction

Answer 6

1. Stasis of Urine flow
   - infection
2. Back-up pressure
   - Hydroureter
   - Hydronephrosis
   - Postrenal AKI (This type of AKI is caused by a urinary obstruction)

Question 7

Manifestations of Acute Obstruction depend on…

Answer 7

Site
Cause
Speed of onset

Mostly Site and Speed play into pain level

Question 8

Nephrolithiasis

Answer 8

Renal calculi or Kidney stones

Location: anywhere between renal pelvis and urethra

Question 9

Nephrolithiasis Risk Factors

Answer 9

Medications
20-30
White
Family Hx
Congenital urinary defect
Weather (hot/dehydration)
Obesity

Question 10

Most common kidney stone

Answer 10

Calcium oxalate 75%

Question 11

Risks for Calcium Oxalate stones

Answer 11

Family Hx
Idiopathic
Inc calcium
Inc oxalate

Question 12

Nephrolithiasis Pathogenesis

Answer 12

Super saturation with solute

Crystals form in nephron

Crystal formation enhanced by:

• Dehydration
• Immobility/sedentary life

Question 13

Acute Renal Colic

Answer 13

• Location: Flank and along groin
• Radiation (comes in waves)
• Spasms
• Intermittent
• Sharp

N/V
Diaphoresis
Inc HR, Inc RR
Dysuria, hematuria

Question 14

Nephrolithiasis: Preventive Meds

Answer 14

Calcium: Thiazide Diuretics
Struvite: Antibiotics
Urate: Allopurinol

Pain: Morphine, NSAIDs
IV Fluids