Non-Glomerular Hematuria

Question 1

Calcium Oxalate or Calcium Phosphate Stones

Answer 1

Most common stone in adults

Alkaline urine, Hypercalciuria, hyperuricosuria, hyperoxaluria

Causes- Idiopathic hypercalciuria, hypercalcemia, Chrons (enteric inc free oxalate)

Tx - Hydrochlorothiazide (Ca-sparing)

Question 2

Ammonium Mag Phosphate Stones

Answer 2

Alkaline urine, Staghorn calculi (nidus for UTI)

Cause- Urease-pos infections (Proteus, klebsiella, serratia, enterobacter)

Tx - May have to surgically remove and eradicate pathogen

Question 3

Uric Acid Stones

Answer 3

Acidic urine

Radiolucent (do not see)

Causes - Pts w/ gout or hyper-uricemia due to nuclear proliferative state (ex - leukemia)

Tx - Hydration, alkalize the urine (K-bicarb), allopurinol if gout

Question 4

Cystine Stones

Answer 4

Most common in kids

Acidic urine, Staghorn calculi, hexagonal crystals

Cause = Genetic - tubule defect so dec reabsorption of cysteine

Tx- Hydration, alkalize urine (K-bicarb), Thiola or D-penicillamine

Question 5

Thiola and D-penicillamine

Answer 5

covalently binds cystine –> soluble

Question 6

Citrate and Sodium Cellulose

Answer 6

• Citrate - inc urinary pH and bind Ca to prevent Ca stones

- Sodium cellulose - also binds Ca but in gut if absorptive hypercalciuria