Nephrolithiasis Flashcards
Risk factors for calcium stones
Hypercalciuria: Higher salt in the diet Higher non-dairy animal protein diet High Sucrose content in the diet Hyperparathyroidism Hypercalciuric Hypocalcemia Hyperoxaluria: Increased intake in high oxalate-containing food Hypocitraturia High urine pH (RTA type I) Low urine volume
Fix hyperoxaluria
Decreased in oral calcium intake
Bind up all the oxalate before absorbed and come out in stool
Risk factors for uric acid stones
Hyperuricemia/hyperuricuria: Gout Polycythemia Vera Tumor lysis syndrome Low urine pH: Obesity, type 2 diabetes mellitus, and high non-dairy animal protein intake
Struvite stones
Chronic infections
Klebsiella or proteus
Cysteine stones
Autosomal recessive disorder
DDx with stones
Acute cholecystitis Acute appendicitis Acute cystitis/pyelonephritis Acute diverticulitis Muscular or skeletal pain Herpes zoster Duodenal ulcer Abdominal aortic aneurysm Ureteral obstruction by materials other than a stone Pelvic Inflammatory Disease
Gold standard stone diagnosis
CT no contrast
Radioluscent
Not calcium
Medical therapy
Pain control Nausea control Propulsive therapy - Calcium channel blockers - Alfa-blockers
Surgical therapy
Ureteroscopy with stone removal and stent placement
Percutaneous nephrostomy
ECWL (lithotripsy)
Large stones
Break into small pieces
Nephrostomy
Allow urine to be passed until stone removed
Recurrence prevention
Diet and fluids
Analyze stone type
Calcium - modify calcium, animal protein, oxalate and water intake, increase potassium
Uric acid - increase urine pH
Prevention medications
Thiazides
- Increase calcium reabsorption and decreases urine Calcium
Allopurinol
- Decreases uric acid in the serum and urine
Potassium Citrate
Magnesium
- Forms soluble complexes with oxalate in the bowel or urine.
