Nephrolithiasis Flashcards
What are the three components of nephrolithiasis etiology?
–Too much solute
–Too little solvent (water)
–“Other” physical conditions (stasis, ph)
What are five risk factors for stone formation?
- Hypercalciuria
- hyperoxaluria
- hypocitraturia
- High urine pH (RTA type I in particular)
- Low urine volume
What are five ways to end up with hypercalciuria?
- Higher salt in the diet
- Higher non-dairy animal protein diet
- High Sucrose content in the diet
- Hyperparathyroidism
- Hypercalciuric Hypocalcemia
What are two causes of hyperoxaluria?
- Increased intake in high oxalate-containing food
- Decreased in oral calcium intake
What are two risk factors for uric acid stones?
Hyperuricemia/hyperuricuria
low urine pH
What patients get uric acid stones d/t hyperuricemia/hyperuricaria?
Those with…
- Gout
- polycythemia vera
- tumor lysis syndrome
What patients get uric acid stones from low urine pH?
Those who are…
- Obese
- DM II
- High non-dairy animal protein intake
What causes cystine stone formation? What is the genetic pattern of inheritance?
Cystinuria (autosomal recessive disorder)
During formation of stones, what is the clinical manifestation?
Asymptomatic
What are the clinical manifestations of stones as it starts to move?
•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
Describe renal colic! (looking for six things here)
- Sudden
- Acute
- Severe
- Non-remitting with positional changes
- Abdominal or back pain
- Unilateral
Give a differential diagnosis list for renal colic type pain other than a stone.
Ballpark 10 things
- •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
How does one develop the diagnosis of a renal stone?
(4 steps)
- •Usually based on clinical presentation
- •Urine: RBC, WBC, crystals
- •Leukocytosis, ARF
- •Imaging
What four methods would you use to image stones?
- –Plain film: May show Calcium stones
- –IVP—used less frequently now
- –CT-renal protocol—gold standard
- –US—may show intrarenal stones and/or hydronephrosis. Not sensitive for ureteral stones
What type of crystals are these?
Calcium Phosphate