NEPHROLITHIASIS (KIDNEY STONES) Flashcards
What is nephrolithiasis
What are the main causes of nephrolithiasis
DEHYDRATION
INCREASED URINE SOLUTE
DECREASED STONE INHIBITORS
- Citrate
- Low pH
- High pH
Clinical manifestations/ symptoms of nephrolithiasis
HEMATURIA
RENAL COLIC
Costovertebral angle (CVA)TENDERNESS
DYSURIA
INCREASED URGENCY
INCREASED FREQUENCY
VOMITING
Complications of nephrolithiasis
HYDRONEPHROSIS
PYELONEPHRITIS
UROSEPSIS
AKI
Types of kidney stones
CALCIUM OXALATE
CALCIUM PHOSPHATE
URIC ACID
STRUVITE STONES/ STAGHORN CALCULI
CYSTINE STONES
Diagnosis of nephrolithiasis
ABDOMINAL & PELVIS CT
RENAL US
KIDNEY URETER BLADDER XRAY
URINALYSIS
URINE MICROSCOPY
24HR URINALYSIS
What kidney stones are formed under low urine pH
Calcium oxalate
Uric acid
Cystine stones
What kidney stones are formed under high urine pH
Calcium phosphate
Struvite stones
What kidney stones are formed due to bacterial infection
Struvite stones
What bacteria causes struvite stones
Klebsiella
Protease
Pseudomonas
What type of kidney stones can be seen in the kidney ureter bladder XRAY
Calcium oxalate
Calcium phosphate
Struvite/ staghorn
Urine microscopy shows dumbbell shaped crystals, what type of kidney stones are is that?
Calcium oxalate
Urine microscopy shows needle shaped crystals, what type of kidney stones are is that?
Uric acid
Urine microscopy shows coffin, rectangular shaped crystals, what type of kidney stones are is that?
Struvite stones
Urine microscopy shows wedge shaped crystals, what type of kidney stones are is that?
Calcium phosphate
Urine microscopy shows hexagon shaped crystals, what type of kidney stones are is that?
Cystine stones
How to treat calcium oxalate stones
1) Fluids for dehydration
2) Treat underlying disease
eg hyperparathyroidism, high calcitriol etc
3) Increase Ca reabsorption
- Decrease Na+ & protein diet
- Use Thiazide diuretics instead of loop diuretics
4) Decrease Oxalate diet
Eg ice tea
5) Don’t restrict Ca diet
- cause low ca diet increases free oxalate in blood
6) Alkalize urine
Potassium citrate
How to treat calcium phosphate stones
1) Fluids
2) Treat underlying disease
3) Increase Ca reabsorption (decrease urine Ca)
- Decrease Na+ & protein diet
- Use Thiazide diuretics instead of loop diuretics
4) Acidify urine
How to treat struvite stones
1) Fluids
2) Antibiotics
4) Acidify urine
How to treat uric acid stones
1) Fluids
2) Treat underlying disease
Gout
Tumor lysis syndrome
Diabetes
DRUG: ALLPURINOL (inhibits uric acid formation)
3) Decrease purine diet
4) Alkalize urine
Potassium citrate
How to treat cystine stones
1) Fluid
2) TYOPRONIN
Binds with cystine
Prevent cystine & amino acid from binding to form stones
3) Alkalize urine
Potassium citrate