Nephrolithiasis Flashcards

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1
Q

what is nephrolithiasis?

A
  • kidney stones also called renal calculi
  • stones develop in kidney can migrate out to anywhere in urinary tract
  • stones in urinary tract (renal calculi)
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2
Q

who is more likely to get kidney stones?

A

-more likely in males (2-3X higher incidence in men)

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3
Q

where does nephrolithiasis originate?

A

-originates in the kidney (could have in both kidneys but generally in 1) then migrates then may cause obstruction

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4
Q

nephrolithiasis (kidney stones) the most common cause of?

A

nephrolithiasis (kidney stones) is the most common cause of obstruction in the urinary tract

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5
Q

what is the etiology of kidney stones?

A
  • complex interaction:
    - increase in concentration of precipitate components in blood & urine
    - structural changes in urinary tract
    - fluid, dietary & metabolic factors (what you eat is what you absorb is what you metabolize)
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6
Q

there are some things that prevent us from forming stones all the time, what are these?

A
  • renal proteins inhibit crystallization

- presence of stone inhibitors eg. magnesium & citrate (prevent stones from forming)

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7
Q

what is the nidus or nucleus?

A

the first particle that begins to form stone

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8
Q

what is the patho of kidney stones

A
  • increase in solute concentration & or urine stasis
  • precipitation in urine
  • nucleus (also called nidus) forms around which other components will accumulate
  • crystallization
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9
Q

there are _____ types of kidney stones

A

4

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10
Q

what are the 4 types of kidney stones?

A
  • calcium (oxolate & phosphate)
  • magnesium ammonium phosphate (strurite)
  • uric acid (urate)
  • cystine
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11
Q

calcium (oxolate & phosphate ) stones

A

Contributing factors:

  • hypercalcemia & hypercalciuria
  • immobilization
  • hyperparathyroidism
  • vitamin D intoxication
  • diffuse bone disease
  • Milk-alkali syndromes
  • renal tubular acidosis
  • hyperoxaluria
  • intestinal bypass surgery

Treatment:

  • treatment of underlying conditions
  • increased fluid intake
  • thiazide diuretics
  • dietary restriction of foods high in oxalate
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12
Q

mnfts of nephrolithiasis (kidney stones)

A
  • very severe colicky pain (minutes to days): intermittent because hurts as stone moves, ureter or urethra distention d/t migration of stone
  • non colicky pain (distention of renal pelvis & calyces stone not attempting to pass
  • N&V from severe pain
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13
Q

Magnesium ammonium phosphate (strurite) stones

A

Contributing factors:
-urea-splitting urinary tract infections

Treatment:

  • treatment of urinary tract infection
  • acidification of urine
  • increased fluid intake
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14
Q

uric acid (urate) stones

A

Contributing factors:

  • formed in acid urine with pH of approx 5.5
  • gout
  • high purine diet

Treatment:

  • increased fluid intake
  • allopurinol for hyperuricosuria
  • alkalinization of urine
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15
Q

cystine stones

A

Contributing factors:
-cystinuria (inherited disorder of amino acid metabolism)

Treatment:

  • increased fluid intake
  • alkalinzation of urine
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16
Q

diagnosing nephrolithiasis (kidney stones)

A
  • the pattern of the pain (dont rely on this)
  • CT, ultrasound (to identify stone)
  • urinalysis (looking for signs of complications: infection, hematuria, proteinuria)
  • IVP (intravenous pyelogram) DONE REGULARLY IN THE PAST SO IT IS V. IMPORTANT THAT I KNOW THIS (administer contrast medium intravenously, goes through blood path visualize path through urethra & glomerulus)
17
Q

treatment of nephrolithiasis (kidney stones)

A
  • supportive treatment
  • small stones passed in urine (when passed collected, analyzed, see if can address diet to prevent)
  • narcotics & antispasmodics (ex. Buscopan)
  • underlying cause? (ex. BPH, obstruction)
  • Surgery may be required (also can blast stones with high frequency sound waves)