Nephrolithiasis 2 (part 1 in IM) Flashcards
urine pH is <5.5 (acidic) suggests what stone type?
Uric Acid Stone
___ aid in stone expulsion by relaxing ureteral smooth muscle.
For treatment of distal ureteral stones sized >5 mm and ≤10 mm.
Alpha-1 antagonists (tamsulosin)
Nephro/Ureterolithiasis complicated by infection (eg, fever, chills) requires urgent _____ because it can rapidly progress from pyelonephritis to severe sepsis and shock.
urologic consultation
Other indications for urgent urologic consultation s/t Nephro/Ureterolithiasis include fever/chills, _____ , refractory pain or vomiting, and ____.
acute kidney injury
anuria
____ presents with flank pain, low-volume voids (poor urine output) ± intermittent high-volume voids, and ± potassium wasting & dehydration, which can cause weakness.
Obstructive uropathy
(mcc: kidney stones, BPH)
Drug-induced rhabdomyolysis can be caused by (8)
Statins /Fibrates
Colchicine
Cocaine / Amphetamines
Opioids / Benzodiazepines
Ethanol
No stone passage in ____ requires outpatient Urology consult
4-6 weeks
Small stones (≤5 mm) have a high probability of passing with expectant management alone (____).
fluids, pain control
Stones that are large (>10 mm), almost always require ____ for resolution.
(outpatient) urologic intervention (lithotripsy, stent placement)
_____ of the abdomen and pelvis are the imaging modalities of choice to confirm the diagnosis of Nephrolithiasis.
Ultrasonography or a noncontrast CT scan
(U/S preferred in pregnant or pediatric patients to reduce radiation exposure)
Young children may have an atypical presentation of nephrolithiasis with isolated ____ in the absence of abdominal or flank pain.
Renal and bladder ultrasound is the preferred imaging study for diagnosing stones in children.
gross hematuria
NBSIM in pediatric patients with glomerular hematuria
(high creatinine, proteinuria)
Complement levels
CBC (if hemolytic cause suspected)
Asymptomatic Hematuria in pediatric patients with normal creatinine. NBSIM
Renal U/S
± Urine culture
Symptomatic Hematuria in pediatric patients with dysuria or pyuria. Diagnosis and NBSIM
UTI
Urine culture
Antibiotic therapy
Symptomatic Hematuria in pediatric patients with perineal/meatal irritation. NBSIM?
Reassurance
Pediatric Patient with nonglomerular hematuria + Abdominal mass?
Diagnosis and NBSIM?
Renal mass (Wilms tumor)
Abdominal CT scan
____ is often suggested by positive blood on UA, but little to no RBCs per hpf on urine microscopy.
rhabdomyolysis
Urine pH >8 (basic) suggests what type of stone?
Struvite (magnesium ammonium phosphate) stones
Infections with Klebsiella, Proteus cause what type of stones?
Struvite (magnesium ammonium phosphate) stones
Magnesium ammonium phosphate (struvite) causes large kidney stones in patients who have recurrent UTIs with urease-producing organisms (Proteus, Klebsiella).
Antibiotics alone do not eliminate struvite stones & ____ is usually required.
complete stone removal
____ complicated by bladder implants typically have cyclic hematuria, dysuria, suprapubic tenderness, and negative urine culture.
Endometriosis
A personal history of recurrent kidney stones from childhood and a positive family history for nephrolithiasis should raise suspicion for what diagnosis?
Urinalysis shows hexagonal crystals.
Cystinuria
Acute ___ presents with dull, constant, non-radiating flank pain, hematuria, ↑ LDH, ↑ kidney size on imaging (w/o hydronephrosis)
mcc are nephrotic syndrome, malignancy, and trauma.
renal vein thrombosis
(Diagnosis can be confirmed by CT or MR angiography or renal venography)
Acute _____ presents with flank + abdominal pain, hematuria, HTN, and wedge-shaped area of ischemia on imaging.
mmc are cardioembolic disease (atrial fibrillation)
renal infarction
Renal colic in pregnancy is associated with abdominal pain, flank tenderness, hematuria, and, often, ______.
irregular uterine contractions
(get an Ultrasound)
In malabsorption syndromes (Crohn disease), there is excess enterically absorbed ___ resulting in calcium oxalate stone formation.
Oxalate
Increased enteric absorption of calcium, induced by calcitriol (the active form of vitamin D), results in hypercalcemia, hypercalciuria, and an increased risk of calcium stones.
Commonly seen in what diseases?
hyperparathyroidism
Sarcoidosis
Granulomatous Diseases
Young adult presents with flank pain & hematuria that is self resolved.
Labs reveal anemia and RBCs on UA.
Increased renal medullary echogenicity seen on ultrasound
Diagnosis?
Renal Papillary Necrosis
(s/t Sickle Cell Trait/Disease)
Drugs with anticholinergic properties (amitriptyline) can cause acute urinary retention by preventing detrusor muscle contraction and urinary sphincter relaxation.
The treatment involves ____
urinary catheterization
discontinuing the medication
____ can affect the genitourinary tract causing neurogenic bladder with urinary retention and distended bladder.
Patients can then develop overflow incontinence (dribbling, poor urinary stream) with a high post-void residual volume (>200ml).
Diabetic autonomic neuropathy
Patients with postpartum urinary retention, the inability to void ≥6 hours after vaginal delivery, may have dribbling of urine from overflow incontinence.
____ indicated for diagnosis and treatment.
Urethral catheterization
Severe ____ can cause recurrent or chronic pyelonephritis. Complications include parenchymal scarring, blunted calyces, hypertension, and renal insufficiency.
vesicoureteral reflux
(commonly girls)
Definitive diagnosis of vesicoureteral reflux is made by ____
voiding cystourethrogram
The most common cause of chronic renal insufficiency/failure in male children.
Can present with obstructed urethra, thick/distended bladder, dilated ureters, and Hydronephrosis.
Posterior urethral valves
Chronic ____ causes urinary stasis and is a risk factor for recurrent cystitis in young children.
constipation
