Nephrolithiasis

Question 1

What is the most common kidney stone

Answer 1

Calcium oxalate

Question 2

List the most common causes of calcium oxalate stones

Answer 2

Ethylene glycol; lethal serum levels of vitamin C; hypocitraturia; Low urine PH; Malabsorption

Question 3

List the most common causes of calcium phosphate crystals

Answer 3

High urine ph

Question 4

Describe the Histologic characteristics of calcium oxalate stones

Answer 4

Envelope or dumbbell in shape

Question 5

Describe the Histologic characteristics of calcium phosphate stones

Answer 5

Wedged-shaped prism crystals

Question 6

Struvite stones consist of what substance

Answer 6

Ammonia magnesium phosphate

Question 7

Describe the histologic characteristics of strubite stones

Answer 7

Staghorn caliculi; coffin lid shaped crystals

Question 8

Struvide stones are commonly caused by what kind of UTI’s

Answer 8

Urease positive pathogens: proteus, Staph. saprophyticus, klebsiella; These microbials hydrolyze urea to Pneumonia which causes urine alkalization; hence the increase in ph

Question 9

Uric acid stones have a strong association with what diseases

Answer 9

Diseases with high cell turnover rates Such as leukemias; hyperuricemia

Question 10

describe the histologic features of uric acid stones

Answer 10

Ron Boyd and Rosette shaped crystals

Question 11

What are common causes for uric acid stones

Answer 11

Low urine PH (below 5.5); decreased urine volume; arid climates; hyperuricosuria

Question 12

Cystic stones are caused by what

Answer 12

Hereditary conditions leading to cysteine malabsorption in the PCT leading to cystinuria

Question 13

reabsorption of wood amino acids are also affected besides cysteine

Answer 13

COLA:
cystine
ornithine
lysine
arginine

Question 14

Histologic characteristics of cysteine stones

Answer 14

hexagonal shaped crystals

Question 15

Patience with Cysteine stones We’ll also test positive for what

Answer 15

Sodium cyanide nitro presside

Question 16

What are major intrinsic risk factors for development of kidney stones

Answer 16

urinary stasis and obstruction; renal tubular acidosis type 1; hyperparathyroidism; uti; medulary sponge kidney; Horseshoe kidney; sarcoidosis

Question 17

what are major extrinsic risk factors for the development of kidney stone

Answer 17

dehydration; High Consumption of animal proteins; glucocorticoids (long-term usage); Carbonic and hydrates inhibitors, Laxatives, loop diuretics; Increased BMI; History of Gout; high sodium diet; excessive consumption of refined sugars; DM; For parathyroidism; decrease calcium intake; Gastrointestinal diseases

Question 18

What ionic compound has a high concentration of oxalates

Answer 18

Sodium chloride

Question 19

UTIS and kidney stones have similar clinical manifestations; except patients with kidney stones also can experience pain to what region besides the flank

Answer 19

colicky painradiating to groin

Question 20

A medulary sponge kidney is associated with what kind of stones

Answer 20

Calcium stones

Question 21

Large stones in the renal pelvis are usually indicative of what kind of kidney stones

Answer 21

Struvite

Question 22

Wood stones are radiopaque and can therefore be seen on an x-ray

Answer 22

calcium, strobite, cysteine

Question 23

nephrocalcinosis Is commonly associated with what type of Kidney stones

Answer 23

More commonly calcium phosphate less commonly calcium oxalate

Question 24

What kind of stones are radiolucent and cannot be seen on a x-ray

Answer 24

Uric acid stones

Question 25

Radio lucent stones are also associated with what drugs

Answer 25

protease inhibitors, xanthine, dihydroxyadenine

Question 26

Where do kidney stones commonly cause obstruction

Answer 26

Junction between the renal pelvis and ureter; Crossing of the ureter over iliac blood vessels; Entrance of the ureter into the bladder also called the Urito Vesicle Junction

Question 27

Where is the gold standard for kidney stone diagnosis

Answer 27

Non contrast CT

Question 28

Will a kidney stone that is five millimeters in diameter pass spontaneously without medical or pharmacologic intervention

Answer 28

yes

Question 29

Pharmacologic therapy is usually not implemented unless the stone is greater than what parameter

Answer 29

greater than five millimeters but less than ten millimeters; A stone greater than 10 Millimeters Will have to be removed by A urologist To avoid further damage to the kidneys And long term complications

Question 30

what is the first line pharmacologic agent to facilitate the passing of the kidney stone

Answer 30

Alpha blockers

Question 31

calcium kidney stones can be treated with what pharmacologic agent

Answer 31

thiazides

Question 32

prophylaxis of calcium & cystine stones can be mediated by what lifestyle modification

Answer 32

Low sodium diet

Question 33

Calcium phosphate stones can specifically be treated with what agent

Answer 33

Citrate

Question 34

What pharmacologic agents can be used to treat uric acid stones

Answer 34

carbonic and hydrates inhibitors and allopurinol (alkalinization of urine)

Question 35

chelating agents such as tiopronin & penicillamine can be used in refractory cases of what stone type

Answer 35

cystine stones

Question 36

What is the mechanism of action for citrate

Answer 36

Forms complexes with calcium to lower urine calcium saturation

Question 37

Besides citrate what are other common stone inhibitors

Answer 37

Urea, magnesium, glyco amino glycans, pyrophosphate; All reduce ionic activity and the formation of crystal complexes

Question 38

What are emergent indications for surgical removal of a stone

Answer 38

Obstructing stones with a active uti; bilateral kidney stones with acute kidney injury; Unilateral obstruction with acute kidney injury and those that only have one functional kidney; All other scenarios are elective indications

Question 39

Summary

Answer 39

make sure to do the review questions on the Nephrolophiasis ppt