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Physiology 2 > Renal - Kidney Stones and Gout > Flashcards

Renal - Kidney Stones and Gout Flashcards

1
Q

Kidney stones tend to obstruct at the level of the _______ resulting in _______

A

ureter

spasms and pain (renal colic)

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2
Q

Main s/s of kidney stones

A

pain and hematuria

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3
Q

Most common type of kidney stone

A

Calcium Oxalate Stone

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4
Q

Are Calcium Oxalate Stones related to high or low dietary Ca intake?

A

Low

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5
Q

Type of kidney stones associated w infection w urea splitting bacteria which form ammonia

A

Struvite Stones

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6
Q

Type of kidney stones seen in gout and cell lysis scenarios

A

Uric Acid Stones

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7
Q

Type of kidney stones associated w hyperparathyroidism and renal tubular acidosis

A

Calcium phosphate stones

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8
Q

Type of stones seen in cysteinuria which is an autosomal recessive d/o of index cysteine reabsorption in the kidney

A

Cysteine Stones

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9
Q

T/F: Most kidney stones are <4 mm and pass spontaneously

A

True

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10
Q

What analgesics help w kidney stone pain?

A

Toradol and opioids

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11
Q

What types of drugs may help decrease tone of ureter and promote passage of kidney stones

A

Terazocin (Alpha blockers) - given by urology, not us.

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12
Q

2 indications for surgical mgmt of kidney stones

A
  • Larger stone
  • Stone has not passed in 30 days
  • Renal compromise
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13
Q

4 types of surgical mgmt for kidney stones

A
  • ESWL
  • Ureteroscopic fragmentation
  • Percutaneous nephrolithotomy
  • Uretral double J stents (allows urine to drain around obstruction)
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14
Q

What is ESWL used for?

A

disintegration of stones in the kidney or ureter above the level of the iliac crest

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15
Q

During ESWL, what is required by the lower energy units to acoustically couple the pt w the energy source

A

liquid on the skin

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16
Q

How does ESWL work?

A

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

17
Q

Where can damage occur during ESWL?

A

air tissue interface (lungs and intestine)

18
Q

Contraindications to ESWL

A
  • inability to properly position pt
  • pregnancy
  • infection
  • obstruction below level of stone
  • proximity to prosthetic device
19
Q

How are shock waves timed so that they are delivered during the ventricular refractory period?

A

20 ms after the R wave

20
Q

How to prevent kidney stones

A
  1. drink water
  2. avoid pop
  3. limit protein, nitrogen, and Na in diet
21
Q

What causes gout?

A

uric acid build up in the joints

22
Q

Is the serum rate necessary elevated in gout pts?

A

No. in 2/3 of cases it is WNL

23
Q

How is gout diagnosed?

A

Microscopy of aspirated fluid

24
Q

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.

A

True

25
Q

2/3 of uric acid excretion is handled by _______; the rest is handled by ________

A

the kidney

the gut

26
Q

Classic profile of a gout pt

A

Black male
Age 40-50s
Likes to consume protein, fat, and ETOH

27
Q

How does acetazolamine help treat gout?

A

it alkalinizes the urine, which traps weak acids

28
Q

Name three drugs/drug classes that help relieve pain from gout

A
  • NSAIDs
  • steroid injection
  • acetazolamide
29
Q

In what case should the xanthine oxidase inhibitor allopurinol not be used?

A

in a transplant pt. it can have a fatal interaction w azathioprine, the transplant drug

30
Q

How do uricocurics prevent gout?

A

promote excretion of uric acid

they compete w uric acid for reabsorption at the level of the organic acid transporter in the kidney

31
Q

T/F Caffeine should be avoided in gout pts

A

False. It may be protective

32
Q

How can CPAP help with gout?

A

Gout is associated w sleep apnea. O2 starved cells die and release uric acid

Physiology 2 (8 decks)

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