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Clin Med 1 - Exam 3 > Nephrolithiasis > Flashcards

Nephrolithiasis Flashcards

1
Q

Describe how furosemide can cause renal stones

A

Increases urinary calcium excretion

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2
Q

True or false. Hyperparathyroidism can lead to nephrolithiasis.

A

True

Hyperparathyroidism increases calcium levels

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3
Q

For patients trying to reduce their risk of kidney stones, should they increase or decrease their dietary intake of protein?

A

Decrease protein intake

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4
Q

Urine pH in patients with struvite stones

A

pH>8

(infections thrive in alkaline conditions)

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5
Q

Treatments (4) for cystine stones

A

Hydration

Alkalinize urine (potassium citrate/Urocit)

Penicillamine for patients who don’t respond to conservative measures

Annual renal US or KUB

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6
Q

Most common type of renal stone

A

Calcium oxalate

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7
Q

As well as increasing fluid volume, drinking this can help reduce a patient’s risk of nephrolithiasis

A

Lemonade (or anything else containing lemon/citrate)

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8
Q

This type of kidney stone most commonly first presents in childhood around the age of 12

A

Cystine stones

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9
Q

Is nephrolithiasis more common in males or females?

A

Males

(males 19%, females 9%)

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10
Q

Patients with struvite stones have recurrent UTIs without e. coli but with these (3) bacteria present

A

Proteus (most common)

Klebsiella

Pseudomonas

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11
Q

Which imaging type best shows uric acid stones?

A

CT scan.

(Uric acid stones are radiolucent, won’t show on x-ray)

(Ultrasound used to see hydronephrosis if stone is in kidney. If stone is in ureter, won’t see on U/S)

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12
Q

Describe how topiramate can cause renal stones

A

Increases urine pH and decreases urine citrate levels

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13
Q

Describe a duplicated collecting system

A

Extra renal pelvis and/or extra ureter

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14
Q

Medication to help aid with passing of kidney stones by relaxing distal ureter

A

Alpha blockers (Tamsulosin) relax distal ureter in men and women

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15
Q

Three treatment methods for uric acid stones

A

Restrict dietary purines

Urinary alkalinization (Sodium bicarb to dissolve stones in short term, Potassium citrate long term)

Allopurinol

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16
Q

Dietary risk factors (7) for nephrolithiasis

A

Fluid intake (low)
Type of fluid (dark soda, tea)
Calcium
Protein
Oxalate
Sodium
Dietary patterns (confounds as FH)

17
Q

Treatment of renal stones induced by drugs indinavir and nelfinavir require acidification or alkalinization of the urine?

A

Acidification

18
Q

When and how to follow-up after kidney stone removal

A

Ensure passage of stone with imaging

Analyze stone/metabolic analysis to find cause

Follow up at six months, then annually, with KUB as recurrence rates high

19
Q

Nephrolithiasis symptoms

A

Often asymptomatic

Abrupt onset flank pain radiating to groin or testicles

20
Q

Most common renal abnormality that contributes to formation of kidney stones

A

Horseshoe kidney

(connected kidneys promotes urinary stasis = stone formation)

21
Q

Urinary risk factors (5) for nephrolithiasis

A

Low urine volume (biggest one)
Hypercalciuria
Hyperoxaluria
Hypocitraturia
Urine pH

22
Q

Medications (5) which can cause nephrolithiasis

A

Topiramate
Acetazolamide
Long term glucocorticoids
Indinavir
Triamterene

23
Q

Kidney stones larger than 2cm may require this invasive procedure

A

Percutaneous nephrostolithotomy

24
Q

Cystine stones can be diagnosed with the presence of two things in the urine. One is cystine, what’s the other?

A

Hexagonal crystals

25
Q

This type of kidney stone runs in families in an autosomal recessive pattern

A

Cystine stones

26
Q

This kidney abnormality causes unilateral obstruction that prevents kidney drainage

A

Congenital UPJ obstruction

27
Q

These types of kidney stones are large and have a characteristic staghorn appearance

A

Struvite stones

28
Q

Procedure to view and remove stones in between kidney and bladder

A

Ureteroscopy

May leave stent in post-stone removal to prevent ureter collapse

29
Q

Kidney stones smaller than this size have an 80% chance of passing on their own

A

<5mm

30
Q

Biggest risk factor for calcium containing kidney stones

A

High levels dietary oxalates

31
Q

Technique using sound waves to break up large renal stones to ease passing

A

Lithotripsy

(aka ESWL = extracorporeal shock wave lithotripsy)

32
Q

Pharmacologic therapy for calcium containing stones

A

Low dose thiazides (HCTZ, chlorthalidone)

Potassium citrate (increase citrate and replace K+ lost form thiazides)

Cholestyramine, Calcium carbonate (if hyperoxaluria)

33
Q

Most definitive imaging for nephrolithiasis

A

CT abdomen/pelvis WITHOUT contrast

34
Q

Area of US with highest prevalence of nephrolithiasis

A

South Eastern US

35
Q

Name the two types of radiopaque kidney stones

A

Calcium containing stones (calcium oxalate and calcium phosphate)

Struvite stones

(Cystine stones are moderately radiopaque)

36
Q

What is the average time to pass kidney stones sized 2-4mm?

A

12.2 days

(95% pass in 40 days)

Clin Med 1 - Exam 3 (12 decks)

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