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Clin Med Renal > Nephrolithiasis > Flashcards

Nephrolithiasis Flashcards

1
Q

What is the 3rd most common urinary tract disorder?

A

Nephrolithiasis

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2
Q

Is nephrolithiasis more common in men or women?

A

Men

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3
Q

What causes neprholithiasis?

A

Ambient concentrations of stone material exceed solubility in urine - allows crystals to grow

Basically “supersaturation” of urine

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4
Q

What could a patient with neprholithiasis be lacking that helps to fight off the production of stones?

A

Inhibitors that retard crystal formation and growth

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5
Q

What could cause supersaturation?

A

Increased excretion of poorly soluble substances

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6
Q

Genetic disorder causing stone formation involving genes SLC2A1 and SLC7A9

A

Cystinuria

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7
Q

What factors can lead to stone formation?

A

Supersaturation PLUS heredity or environment (diet, obesity)

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8
Q

Most common type of urinary stone?

A

Calcium oxalate

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9
Q

What are the different types of urinary stones?

A 
Calcium oxalate
Calcium phosphate
Struvite
Uric acid
Cystine
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10
Q

Frequently have smooth-edge ground-glass appearance

A

Cystine stones

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11
Q

Can be radiolucent

A

Uric acid stones

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12
Q

If a uric acid stone is radiopaque, it must be combined with??

A

Calcium

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13
Q

What are some things that can cause calcium stones?

A 
Idioipathic hyeprcalciuria
Primary hyperparathyroidism
Hypocitraturia
Hyperuricosuria
Renal tubular acidosis
Hyperoxaluria (Dietary, enteric, primary)
Colon resection, ileostomy
Habit, environment
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14
Q

Produced by UTI with urease-producing bacteria; Usually greater than 2cm (large)

A

Struvite stone

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15
Q

What bacteria could cause a struvite stone?

A

Proteus, Klebsiella, pseudamonas, enterobacter

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16
Q

What is the treatment for Struvite stones?

A

Prevent UTIs

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17
Q

What causes uric acid stones?

A

Low 24h urine pH (less than 5.6)

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18
Q

What are some common comorbidities in patients with uric acid stones?

A

Obese or diabetic - both decrease urine pH via insulin resistance

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19
Q

What is the treatment for uric acid stones?

A

Increase urine pH to greater than 6 with potassium citrate

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20
Q

What are some other things a patient can do to prevent uric acid stones?

A

Allopurinol

Low purine diet (decrease fish, shellfish, meats)

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21
Q

Cystine stones are caused by an ____ ____ inherited abnormality

A

Autosomal recessive

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22
Q

How do you treat cystine stones?

A

Increase urine volume to 3L daily and increase urine pH to greater than 7 with potassium citrate

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23
Q

What agents may be used to prevent cystine stones?

A

Chelating agents

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24
Q

Geographic risk factors for nephrolithiasis include?

A

High humidity

High temperature

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25
Q

What type of diet can increase risk factors for nephrolithiasis?

A

High animal protein diet

High salt intake

26
Q

A family history risk factor for nephrolithiasis is having a ___ ____ relative with a history of calcium stones

A

1st degree

27
Q

Will decreasing calcium in the diet help decrease the risk for nephrolithiasis?

A

No! In fact it could increase the risk because your body will absorb more oxalate from diet

28
Q

What are the most common signs and symptoms of nephrolithiasis?

A

Unilateral flank pain
Sudden onset
Renal colic
Hematuria

29
Q

If your patient has persistent urinary frequency without evident infection, where could a stone be located?

A

Ureterovesical junction

30
Q

Gold standard for the diagnosis of kidney stones?

A

Non-contrast CT

31
Q

What types of radiography could you get to diagnose nephrolithiasis?

A

Non-contrast CT*
KUB x-rays
Intravenous pyelography
Renal ultrasonography

32
Q

What is the benefit of doing a CT scan on a patient with suspected nephrolithiasis?

A

Stone type can be suggested by radiographic density

33
Q

Low radiographic density

A

Uric acid or cystine

34
Q

High radiographic density

A

Calcium

35
Q

Have a laminar rugged appearance, often full casts of the renal pelvis and calyces. “Stag horn” conformation

A

Struvite stones

36
Q

What is the procedure of choice for diagnosing nephrolithiasis in a patient who needs to avoid radiation (pregnancy, etc.)

A

Ultrasound

37
Q

Limitations of X-ray when diagnosing nephrolithiasis

A

Will show large radiopaque stones like calcium, struvite, and cystine but will MISS radiolucent uric acid stones and could also miss small stones

will NOT detect obstruction

38
Q

Why is IVP no longer the diagnostic procedure of choice?

A

Potential contrast reactions, lower sensitivity, and higher radiation exposure than non-contrast CT

39
Q

What would you want to order to workup nephrolithiasis?

A

Urinalysis for blood and cystine crystals
Stone analysis
BMP (check calcium and creatinine); Thyroid
24 hour urine analysis for recurrent stone formers

40
Q

What is the most common abnormality found in patients who produce recurrent calcium stones?

A

Idopathic hypercalcuria

Elevated excretion of calcium with normal blood calcium

41
Q

What is the best way to acutely manage a patient with nephrolithiasis?

A

Pain management (opiods, NSAID)
Hydration
Strain urine

42
Q

When should you consider hospitalization of a patient with nephrolithiasis?

A

Cannot tolerate oral intake

Uncontrolled pain or fever

43
Q

How long before shock wave lithotripsy does a patient need to stop taking their NSAIDs?

A

3 days

44
Q

Possible advantage of decreasing ureteral smooth muscle tone thereby directly treating mechanism (ureteral spasm)

A

NSAIDs

45
Q

When does a patient with nephrolithiasis need extracorporeal shock wave lithotripsy or rigid and flexible ureteroscopy?

A

Stone greater than 10mm

Urosepsis requiring emergent decompression

46
Q

What is emergent decompression?

A

When a patient needs a stent or nephrostomy tube to pass a kidney stone

47
Q

Most stones less than or equal to __mm will pass spontaneously

A

5mm

48
Q

Stones that are greater than or equal to ___mm will not pass on their own

A

10mm

49
Q

What is the most important indicator of stone passage?

A

Size

50
Q

Stones located in the ____ ____ are less likely to pass spontaneously compared to stones in the ureterovesicular junction

A

Proximal ureter

51
Q

Stone passage is significantly more likely and occurs faster with ____ vs conservative treatment alone

A

Flomax

52
Q

Alpha blocker

A

Tamsulosin (Flomax)

53
Q

Calcium channel blocker that may increase passage rate of ureteral stones

A

Nifedipine

54
Q

When should you have your patient consult urology?

A 
Urosepsis
Renal failure
Obstruction
Solitary kidney
Concomitant pyelonephritis
Stone greater than 10mm
Have not passed stone in 4-6 weeks
55
Q

What are the 3 minimally invasive surgical techniques available for removal of a kidney stone?

A

Shock wave lithotripsy
Percutaneous nephrolithotomy
Rigid and flexible ureteroscopy with or without stent placement

56
Q

Treatment of choice for most small (Proximal) renal calculi

A

SWL (Shock wave lithotripsy)

57
Q

Treatment of choice for stone removal of larger (greater than 2cm) renal stones including stag horn calculi

A

Percutaneous nephrolithotomy (PNL)

58
Q

Treatment of choice for the majority of middle and distal ureteral stones and ureteral calculi that have failed shock wave lithotripsy

A

Ureteroscopy

59
Q

___ patients will experience stone recurrence within 5 years

A

1/3

60
Q

___ patients will experience stone recurrence within 10 years

A

1/2

61
Q

What is key for preventing nephrolithiasis?

A

Increase fluid intake! Maintain urine volume of greater than 2L

62
Q

What diet changes can be made to decrease Ca+ Oxalate stone formation?

A

Decrease oxalate intake (rhubarb, spinach, nuts, seeds)
Decrease animal protein intake
Decrease sodium intake
Increase fluid intake

Clin Med Renal (4 decks)

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