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Nephrology > Nephrolithiasis > Flashcards

Nephrolithiasis Flashcards

1
Q

Calcium Stones

Frequency and Causes

A
  • It is the most common 80% (oxalate is more common than phosphate)
  • Idiopathic hypercalciuria (most common cause)
  • Primary hyperparathyroidism
  • Hypocitraturia that will result in decreased urine pH, it can be caused by:
  • Metabolic acidosis (removes Ca++ from bones and decrease citrate levels)
  • Ethylene glycol (anti-freeze) ingestion
  • Vitamin C abuse
  • Malabsorption like Crohn’s disease (increase oxalate absorption)
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2
Q

Ammonium magnesium phosphate (Struvite) Stones

Frequency and Causes

A
  • About 15%
  • Infection with urease +ve bugs like:
  • P. mirabilis
  • S. saprophiticus
  • Klebsiella
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3
Q

Uric acid Stones

Frequency and Causes

A
  • About 5%
  • Decreased urine volume
  • Arid climate
  • Acidic pH
  • Gout
  • Xanthine oxidase deficiency
  • High purine turnover states like chemotherapy
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4
Q

Cystine Stones

Frequency and Causes

A
  • Very rare
  • Hereditary (AR) condition with loss of function of the Cystine-reabsorbing transporter at the PCT causing cystinuria. Also the defect results in poor reabsorption of Ornithine, Lysine, and Arginine (COLA)
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5
Q

Calcium oxalate Stones

Urine crystal shape

A

Back of envelop or dumbbell

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6
Q

Calcium phosphate Stones

Urine crystal shape

A

Wedge-shaped prism

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7
Q

Ammonium magnesium phosphate (Struvite) Stones

Urine crystal shape

A

Coffin lid

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8
Q

Uric acid Stones

Urine crystal shape

A

Rhomboid or rosettes

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9
Q

Cystine Stones

Urine crystal shape

A

Hexagonal

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10
Q

Calcium oxalate Stones

X-ray and CT findings

A

Radiopaque on both

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11
Q

Calcium phosphate Stones

X-ray and CT findings

A

Radiopaque on both

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12
Q

Ammonium magnesium phosphate (Struvite) Stones

X-ray and CT findings

A

Radiopaque on both

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13
Q

Uric acid Stones

X-ray and CT findings

A
  • Radiolucent on X-ray

- Can be visualized on CT

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14
Q

Cystine Stones

X-ray and CT findings

A

Radiopaque on both

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15
Q

Calcium oxalate Stones

pH changes

A

Decreased pH

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16
Q

Calcium phosphate Stones

pH changes

A

Increased pH

17
Q

Ammonium magnesium phosphate (Struvite) Stones

pH changes

A

Increased pH

18
Q

Uric acid Stones

pH changes

A

Decreased pH

19
Q 
Cystine Stones
(pH changes)
A

Decreased pH

20
Q

Renal Stones

Presentation

A
  • Acute onset of severe, colicky flank pain that may radiate to the testes or vulva
  • There may be associated nausea and vomiting
  • Patients are unable to get comfortable and shift position frequently
21
Q

Renal Stones

Diagnosis

A
  • CT scan to detect the stone and any obstruction like hydronephrosis if present
  • U/S is preferred over CT scan in pregnant women and children
  • Urine analysis may show gross or microscopic hematuria and an altered urine pH
  • We can determine the etiology of the stone by doing the following:
  • Stone analysis
  • Sodium cyanide nitroprusside test is +ve in cystine stones
  • Serum Ca++, sodium, uric acid, PTH, magnesium, and phosphate levels
  • 24-hour urine volume for Ca++, oxalate, citrate, cystine, pH, uric acid, phosphate and Mg++
22
Q

Renal Stones

General Treatment

A
  • Acute episode should be managed with hydration and analgesia like Ketorlac (NSAIDs that can be given orally and IV that provides a level of analgesia similar to opiate medications)
  • Stones < 5 mm pass spontaneously
  • Stones 5-7 mm can be passed with the help of nifedipine + tamsulosin
  • Stones between 0.5 and 2 to 3 cm can be managed with lithotripsy (Extracorporeal shock-wave lithotripsy [ESWL])
  • Large stones are removed surgically by percutaneous nephrolithotomy or retrograde ureteroscopy
  • Stones halfway up the ureters are treated with lithotripsy. Stones halfway down the ureters are removed from below with a basket
  • Stent-placement relieves hydronephrosis from stones caught in distal ureters
23
Q

Calcium oxalate Stones

Specific Treatment

A
  • Hydration
  • Thiazides
  • Alkalinization of urine with citrate
  • Low sodium and protein diet
  • Increase Ca++ intake
24
Q

Calcium phosphate Stones

Specific Treatment

A
  • Hydration
  • Thiazides
  • Increase Ca++ intake
25
Q

Ammonium magnesium phosphate (Struvite) Stones

Specific Treatment

A
  • Hydration
  • Eradication of the underlying infection
  • Surgical removal of the stones
26
Q

Uric acid Stones

Specific Treatment

A
  • Hydration
  • Alkalinization of urine with citrate
  • Dietary purine restriction
  • Allopurinol
27
Q

Cystine Stones

Specific Treatment

A
  • Hydration
  • Low sodium diet
  • Alkalinization of urine with citrate
  • Chelating agents like penicillamine if refractory
28
Q

Causes of Staghorn Stones

A
  • Ammonium magnesium phosphate (struvite) stones

- Cystine stones

29
Q

Renal Stones

Prognosis

A

50% of patients with kidney stones will have a recurrence over the next 5 years

30
Q

Renal Stones

Complications

A
  • Hydronephrosis

- Pyelonephritis

Nephrology (7 decks)

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