Nephrolithiasis Flashcards
1
Q
nephrolithiasis
A
- renal calculi
- stones in the UT
- 2-3 x higher risk in men
- originate in 1 kidney (unilateral origin) and are asympt until they migrate and cause an obstr
2
Q
etiology
A
- multifactorial:
~fluid, dietary and metabolic factors
~increased concentration of precipitate components in blood and urine
~structural changes in UT (ex. BPH)
3
Q
nidus
A
aka nucleus, initial particle that appears, attracts other components, forming a stone
4
Q
patho
A
- kidney prod proteins that inhibit crystallization of the components in the urine (defense mechanism) -> inadequate/defective proteins will lead to crystallization
- presence of stone inhibitors (eg. Mg and citrate) -> present in urine and inhibit stones from forming
- increased [solute] and/or urine stasis = ppt of solute w/in urine and likely formation of stones
- nucleus -> crystallization
5
Q
staghorn calculus
A
neatly lodged stones; refer to shape and size
6
Q
types of stones
A
- calcium (oxalate and phosphate)
- magnesium ammonium phosphate (struvite)
- uric acid (urate)
- cystine
7
Q
manifestations
A
- renal colic -> very severe, intermittent pain (min-days)
- ureter distention d/t migration (colicky)
- distention of renal calyces and pelvis (non-colicky pain)
- n/v
8
Q
diagnosis
A
- pain presentation
- US/CT -> detect stone location and # of stones
- urinalysis -> r/o infection, see if kidney fx impacted
- IVP
9
Q
IVP
A
- intravenous pyelogram
- contrast medium into vein -> heart -> pulm circuit -> arterial system -> kidney -> glomerulus -> contrast filtered into filtrate -> ureter -> bladder -> urethra
10
Q
treatment
A
- narcotics and antispasmodics (buscospan)
- antiemetics
- small stones (<5mm) passed in urine
- underlying cause (ex. BPH, fluid intake, diet mod)
- sx (not open sx unless stone is large)
- lithotrypsy
11
Q
lithotrypsy
A
use high frequency soundwaves to break stone into fragments and the small fragments are passed out the urethra
