Renal Calculi / Nephrolithiasis

Question 1

What is nephrolithiasis?

Answer 1

Stones in the urinary tract

Question 2

Who is more at risk for renal calculi, men or women?

Answer 2

Men are 2-3x more likely

Question 3

What is the progression of a kidney stone? Starting from origin:

Answer 3

• Unilateral origin
• Migration
• Obstruction

Question 4

What is the Et of nephrolithiasis?

3

Answer 4

Several interacting factors

• Fluid, dietary, and metb
• Supersaturated urine
• Structural changes
  
  • As seen in benign prostatic hyperplasia

Question 5

A proposed effect of renal proteins in relation to renal calculi is that they…

Answer 5

…inhibit crystallization

Question 6

What are 2 examples of stone inhibitors?

Answer 6

• Mg

- Citrate

Question 7

Patho of nephrolithiasis:

Answer 7

Increased solute and/or urine stasis -> precipitate in urine -> nucleus -> crystallization -> renal calculi

Question 8

What are 4 types of kidney stones?

Answer 8

1. Calcium (oxalate and phosphate)
2. Magnesium ammonium phosphate (struvite)
   
   • AKA Staghorn?
3. Uric acid (urate)
4. Cystine

Question 9

What are the mnfts of renal calculi?

5

Answer 9

• Very severe renal colic
  
  • Can last minutes - days
• Distended ureter d/t migration
• Distension of renal pelvis and calyces (non-colic-y)
• Nausea/vomiting
• Diaphoretic

Question 10

What Dx are used for nephrolithiasis?

4

Answer 10

• Pain presentation
• US, CT
• Urinalysis
• IVP
  
  • Pyelogram

Question 11

What is the Tx of kidney stones?

Answer 11

• Narcotic and antispasmodics
• 90% voided with urine (<5mm)
• Treat cause
• Sx ??
  
  • Lithotripsy
    - Shock waves used to break stone