PH - UR

Question 1

In which 3 common sites do renal calculi (kidney stones) commonly get stuck?

Answer 1

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

Question 2

Name 2 conditions that predispose calcium stone formation

Answer 2

medullary sponge kidney

polycystic kidney disease

Question 3

What is hyperoxaluria? What does it predispose to? name 3 causes of it

Answer 3

A. High oxalate levels excreted by the kidney

B. predisposes to formation of calcium oxalate crystals (even when calcium is normal)

Causes: high dietary intake (spinach), chronic malabsorption, primary hyperoxaluria (rare AR enzyme deficiency = high production of oxalate)

Question 4

How do certain UTIs lead to stone formation?

Answer 4

Organisms produce urease (lebsiella, proteus)

= ammonium, magnesium and calcium
containing stones

Question 5

A urine dipstick in renal calculi is usually

positive for what? (90%)

Answer 5

Blood

Question 6

List 4 investigations that might be performed

in renal colic

Answer 6

Mid-stream stream urine culture

Urine dipstick

U and Es

Abdominal x ray

Spiral CT - first choice

Question 7

What is the initial management of renal colic?

3

Answer 7

Diclofenac (analgesia)

IV fluids (if unable to drink)

Cefuroxime (antibiotics)

Question 8

What is the medical treatment to aid passing
of a renal stone?

(>5mm)

Answer 8

Nifedipine

Or alpha blockers (tamulosin)

Prednisolone (to lower inflammation)

advanced: if no cleared in 48hrs
Shockwave lithotripsy (ESWL) - ultrasound waves to break stone

Percutaneous nephrolithotomy (PCNL) - keyhole surgery

Question 9

What is the prevention strategy for uric acid

stones?

Answer 9

Xanthine oxidase inhibitor

allopurinol

Question 10

What protein does PKD1 code for? What does

this protein do?

Answer 10

Polycystin-1

Integral membrane protein which regulates
tubular and vascular development of kidneys
ADPKD - also PKD2