Nephrolithiasis Flashcards

1
Q

What are the three components of nephrolithiasis etiology?

A

–Too much solute
–Too little solvent (water)
–“Other” physical conditions (stasis, ph)

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2
Q

What are five risk factors for stone formation?

A
  1. Hypercalciuria
  2. hyperoxaluria
  3. hypocitraturia
  4. High urine pH (RTA type I in particular)
  5. Low urine volume
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3
Q

What are five ways to end up with hypercalciuria?

A
  • Higher salt in the diet
  • Higher non-dairy animal protein diet
  • High Sucrose content in the diet
  • Hyperparathyroidism
  • Hypercalciuric Hypocalcemia
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4
Q

What are two causes of hyperoxaluria?

A
  • Increased intake in high oxalate-containing food
  • Decreased in oral calcium intake
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5
Q

What are two risk factors for uric acid stones?

A

Hyperuricemia/hyperuricuria

low urine pH

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6
Q

What patients get uric acid stones d/t hyperuricemia/hyperuricaria?

A

Those with…

  1. Gout
  2. polycythemia vera
  3. tumor lysis syndrome
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7
Q

What patients get uric acid stones from low urine pH?

A

Those who are…

  1. Obese
  2. DM II
  3. High non-dairy animal protein intake
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8
Q

What causes cystine stone formation? What is the genetic pattern of inheritance?

A

Cystinuria (autosomal recessive disorder)

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9
Q

During formation of stones, what is the clinical manifestation?

A

Asymptomatic

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10
Q

What are the clinical manifestations of stones as it starts to move?

A

•Renal colic when stone moves through and/or obstructs one of the ureters
•Micro- or macro-hematuria
•Sometimes associated with UTI
–Fever/leukocytosis/pyuria/sepsis

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11
Q

Describe renal colic! (looking for six things here)

A
  • Sudden
  • Acute
  • Severe
  • Non-remitting with positional changes
  • Abdominal or back pain
  • Unilateral
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12
Q

Give a differential diagnosis list for renal colic type pain other than a stone.

Ballpark 10 things

A
  1. •Acute cholecystitis
  2. •Acute appendicitis
  3. •Acute cystitis/pyelonephritis
  4. •Acute diverticulitis
  5. •Muscular or skeletal pain
  6. •Herpes zoster
  7. •Duodenal ulcer
  8. •Abdominal aortic aneurysm
  9. •Ureteral obstruction by materials other than a stone
  10. •Pelvic Inflammatory Disease
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13
Q

How does one develop the diagnosis of a renal stone?

(4 steps)

A
  1. •Usually based on clinical presentation
  2. •Urine: RBC, WBC, crystals
  3. •Leukocytosis, ARF
  4. •Imaging
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14
Q

What four methods would you use to image stones?

A
  1. –Plain film: May show Calcium stones
  2. –IVP—used less frequently now
  3. –CT-renal protocol—gold standard
  4. –US—may show intrarenal stones and/or hydronephrosis. Not sensitive for ureteral stones
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15
Q

What type of crystals are these?

A

Calcium Phosphate

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16
Q

Crystal type?

A

Calcium oxalate

17
Q

Type of crystals?

A

Urate

18
Q

What type of crystals?

A

Struvate

19
Q

Stone type and most likely causative agent?

A

Struvite stone (magnesium ammonium phosphate)

Proteus Mirabilus

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24
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26
Q

What are the medical and surgical therapies for acute attacks?

A

•Medical Therapy
–Pain control
–Nausea control
–Propulsive therapy
•Calcium channel blockers
•Alfa-blockers
•Surgical Therapy
–Ureteroscopy with stone removal and stent placement
–Percutaneous nephrostomy

27
Q

What is the treatment after acute attack?

A

•ECWL (lithotripsy) if large stones

28
Q

How does lithotripsy work?

A
29
Q

What steps do you need to take in order to prevent recurrance of stones?

A

•Analyze the stone
•Collect the information about dietary preferences and fluid intake
•Serum Ca, Phosphorus, uric acid
•If Ca is elevated, do hypercalcemia work-up
–PTH, Vit D level, Protein electrophoresis
•24 urine collection for Ca, urate, oxalate, citrate

30
Q
A