Renal - Kidney Stones and Gout Flashcards
Kidney stones tend to obstruct at the level of the _______ resulting in _______
ureter
spasms and pain (renal colic)
Main s/s of kidney stones
pain and hematuria
Most common type of kidney stone
Calcium Oxalate Stone
Are Calcium Oxalate Stones related to high or low dietary Ca intake?
Low
Type of kidney stones associated w infection w urea splitting bacteria which form ammonia
Struvite Stones
Type of kidney stones seen in gout and cell lysis scenarios
Uric Acid Stones
Type of kidney stones associated w hyperparathyroidism and renal tubular acidosis
Calcium phosphate stones
Type of stones seen in cysteinuria which is an autosomal recessive d/o of index cysteine reabsorption in the kidney
Cysteine Stones
T/F: Most kidney stones are <4 mm and pass spontaneously
True
What analgesics help w kidney stone pain?
Toradol and opioids
What types of drugs may help decrease tone of ureter and promote passage of kidney stones
Terazocin (Alpha blockers) - given by urology, not us.
2 indications for surgical mgmt of kidney stones
- Larger stone
- Stone has not passed in 30 days
- Renal compromise
4 types of surgical mgmt for kidney stones
- ESWL
- Ureteroscopic fragmentation
- Percutaneous nephrolithotomy
- Uretral double J stents (allows urine to drain around obstruction)
What is ESWL used for?
disintegration of stones in the kidney or ureter above the level of the iliac crest
During ESWL, what is required by the lower energy units to acoustically couple the pt w the energy source
liquid on the skin
How does ESWL work?
Tissue has the same acoustic density as water so waves travel through the body w/o hurting tissue. Impedance by the stone causes it to be broken apart
Where can damage occur during ESWL?
air tissue interface (lungs and intestine)
Contraindications to ESWL
- inability to properly position pt
- pregnancy
- infection
- obstruction below level of stone
- proximity to prosthetic device
How are shock waves timed so that they are delivered during the ventricular refractory period?
20 ms after the R wave
How to prevent kidney stones
- drink water
- avoid pop
- limit protein, nitrogen, and Na in diet
What causes gout?
uric acid build up in the joints
Is the serum rate necessary elevated in gout pts?
No. in 2/3 of cases it is WNL
How is gout diagnosed?
Microscopy of aspirated fluid
T/F: Although 75% of first gout attacks involve the big toe, uric acid deposits can also occur in soft tissue and kidney stones can form.
True
2/3 of uric acid excretion is handled by _______; the rest is handled by ________
the kidney
the gut
Classic profile of a gout pt
Black male
Age 40-50s
Likes to consume protein, fat, and ETOH
How does acetazolamine help treat gout?
it alkalinizes the urine, which traps weak acids
Name three drugs/drug classes that help relieve pain from gout
- NSAIDs
- steroid injection
- acetazolamide
In what case should the xanthine oxidase inhibitor allopurinol not be used?
in a transplant pt. it can have a fatal interaction w azathioprine, the transplant drug
How do uricocurics prevent gout?
promote excretion of uric acid
they compete w uric acid for reabsorption at the level of the organic acid transporter in the kidney
T/F Caffeine should be avoided in gout pts
False. It may be protective
How can CPAP help with gout?
Gout is associated w sleep apnea. O2 starved cells die and release uric acid
