Nephrolithiasis/Kidney stones/Renal calculi/Urinary stones

Question 1

Kidney stones

Answer 1

Masses of crystals, protein, or other substances obstruct UT

Question 2

Why would kidney stones reoccur?

Answer 2

Recur if the underlying cause is not treated

Question 3

What determines if a kidney stone will pass?

Answer 3

Size of stone determines if will pass (5mm vs 1cm)

Question 4

Crystallization

What does it eventually lead to?

Answer 4

Crystallization – one tiny crystal forms, deposits continue to build

Eventually forms large mass & can get stuck as descends, obstructing urine

Question 5

Risk factors for kidney stone?

Answer 5

Genetic predisposition

Urine stasis occurs with urinary tract obstruction and can lead to the formation of renal calculi

Dehydration leads to concentrated urine, supersaturation of waste products (urate,
calcium oxalate), and then, crystal formation

Question 6

How are kidney stone classified?

Answer 6

Classified by the minerals that make up the stone

Question 7

pH urine: Alkaline urine pH> 7 leads to increased risk of what kind of stone formation?

Answer 7

calcium phosphate struvite stone

Question 8

pH urine: Acidic urine pH < 5 leads to increased risk of what kind of stone formation?

Answer 8

uric acid stone formation

Question 9

Stones can be classified according to the primary minerals (salts) that make up the stones.

The most common stone types include

Answer 9

The most common stone types include calcium oxalate or phosphate (70% to 80%), struvite (magnesium-ammonium-phosphate) (15%), and uric acid (7%). Cystine stones are rare (<1%).

Question 10

Kidney stone formation is related to:

Answer 10

1. supersaturation of one or more salts in the urine,
2. precipitation of the salts from a liquid to a solid state,
3. growth through crystallization or agglomeration (sometimes called aggregation)
4. the presence or absence of stone inhibitors (e.g., uromodulin [Tamm-Horsfall protein])

Question 11

Supersaturation

Answer 11

Presence of a higher concentration of salt within a fluid than the fluid is able to dissolve to maintain equilibrium.

Question 12

Clinical manifestation of kidney stones

Answer 12

Renal colic

nausea and vomiting

hematuria may be present.

groin and flank pain

Question 13

Renal colic

Answer 13

Renal colic is pain related to dilation and spasms of smooth muscle related to ureteral obstruction.

Question 14

Complications with kidney stones:

Answer 14

Infection + blocked ureter = accumulation of urine in the ureter with results in hydronephrosis

Question 15

Hydronephrosis

Answer 15

accumulation of water/urine in the kidneys (big risk for infection)

Question 16

Kidney stone treatment?

Answer 16

High fluid intake

Avoid dietary oxalate (chocolate, beets, nuts, rhubarb, spinach, strawberries, tea, wheat bran)

less animal protein

limit sodium intake

Question 17

Mr. McStoney and kidney stone treatment:

Answer 17

1. Drink water- lots
2. Limit sodium
3. Eat a moderate amount of protein
4. Eat enough calcium

Question 18

What would indicate obstruction of the renal pelvis or proximal ureter

Answer 18

Moderate to severe pain often originates in the flank and radiates to the groin, and usually indicates obstruction of the renal pelvis or proximal ureter.

Question 19

What would indicate obstruction of the midureter

Answer 19

Colic that radiates to the lateral flank or lower abdomen typically indicates obstruction in the midureter.

Question 20

What would indicate obstruction of the lower ureter or ureterovesical junction?

Answer 20

lower urinary tract symptoms (urgency, frequent voiding, urge incontinence) indicate obstruction of the lower ureter or ureterovesical junction.