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nephrology fellowship reviewer > 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
Q

most likely cause of nephrolithiasis in a patient with distal RTA

A

hypocitraturia

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26
Q

depressions near the papillary tips, yellow crystalline deposits in the ducts of bellini, some randall plaques

A

Calcium phosphate

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27
Q

1st kidney stone work up

A

medical hx, stone analysis, urine analysis

28
Q

Recurrent kidney stone

A

full metabolic evaluation - serum panel, PTH, VitD if hyperCa, 24ag urine >= 2 samples Na Ca Oxalate Uric acid citrate

29
Q

indicative of minimal fluid intake

A

urine volume less than 2.5L

30
Q

pH with increase risk of uric acid precipitation, idiopathic uric acid stone, intestinal disease and diarrhea and intestinal bypass surgery

A

less than 5.5

31
Q

Increase risk of caphos precipitation, dRTa, primary hyperparathyroidism, alkali, ca tx

A

pH > 6.7

32
Q

pH that indicates urinary tract infection fom urease producing bacteria

A

> 7-7.5

33
Q

Normal UCrea

A

F: 15-20 mk
M: 20-25 mk

34
Q

reflects dietary Na and K intake

A

24H urine Na and K

35
Q

Major cause of hypercalciuria

A

High Na intake

36
Q

Normal Urine Na K Ca

A

Na 100 K 40-60 Ca < 250-300 mg

37
Q

Low Mg increases risk of

A

calcium stones

UMg <30-120 mg

38
Q

UOxalate > 100 mg/day

A

primary hyperoxaluria

39
Q

Higher Uphos > 1100 mg

A

calcium phosphate formation

40
Q

hyperuricosuria, Uuric acid > 600-800

A

CaOx stones Uph > 5.5

Uric acid stones UpH <5.5

41
Q

marker of dietary acid intake

A

sulfate

42
Q

high ammonium/sulfate ratio

A

GI alkali loss

43
Q

Normal Urine NH4

A

30-40 meq

44
Q

Petsistent high Uca on a restricted diet

A

intestinal hyperabsorption of Ca

45
Q

Elevated fasting Ca/Crea (0.11 mg/100 ml or <2.7 umil/100 mg), high serum calcium, elevated pth

A

primary hyperparathyroidism

46
Q

Elevated Ca/Crea, normal serum Ca, normal or suppressed PTH

A

resoprtive hypercalciuria

47
Q

elevated Ca/Cr, normal Ca, elevated pth

A

Renal hypercalciuria

48
Q

Elevated Ca/Cr (0.2 mg/mg or 0.56 mmol/mmol) 4h Ca/Crea after 1 g oral load

A

absorptive hypercalciuria

49
Q

dumbless shaped crystals

A

calcium oxalate monohydrate

50
Q

Envelope shaped crystals

A

calcium oxalate dihydrate

51
Q

Flat shaped or wedge shaped prisms, often in rosettes

A

Calcium phosphate

52
Q

Gold standard for kidney stone diagnosis

A

noncontrast ct
un enhanced ct scan
ct stonogram

53
Q

time when surgical intervention is indicated

A

4 weeks

54
Q

average days of stone passage

A

40 days

55
Q

medical expulsive therapy

A

ccb, steroids, a-blockers

56
Q

target fluid intake

A

Urine volume > 2.5L

cystinuria > 4L water intake

57
Q

Dietary mgt

A 
Na < 100 meq/day 
animal protein 50-60 g/day 
Ca 1000-1200 mg 
avoid > 1g Vit C 
Fruits/vegetables
58
Q

Drug of choice hypercalciuria in caOx and Caphos stone formers

A

Thiazides 25 bid

59
Q

Tx hypocitraturia in caox and caphos, uric acid stones, cystine stones

A

20-80 meqs 3-4 doses

uric acid: pH goal > 6, cysteine pH > 7,

60
Q

Treatment Ca stone formers with hyperuricosuria

A

Allopurinol 100-300 mg/d

61
Q

cystine stones

A

penicillamine

62
Q

Struvite stones when other interventions have failed

A

acetohydroxamic acid 15 mkd

63
Q

first line therapy for uric acid stone formers

A

Urine alkalinization

64
Q

tx of choice struvite stones, impacted stone; largest stone free rate and less recurrenfe rate

A

percutaneous nephrolithotomy

65
Q

hexagonal stones- tx

A

Cystine, tiopronin

66
Q

coffin lid like

A

struvite

67
Q

uric acid stones are

A

pleomorphic

nephrology fellowship reviewer (29 decks)

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