Renal Lithiasis Flashcards
Who is more prone?
males > females
whites>hispanics>blacks
why does the incidence of kidney stones seem to be increasing?
becuase of rise in metabolic syndrome in us population
what population has shown the highest increase in kidney stones?
children, particularly black female (teens)
what is a typical pt for a kidney stone?
white male in his 30s to 40s
what kind of stone accounts for 80% of stones, usually paired w/ oxalate, radio-opaque?
calcium stones
these stones account for <10% of stones
uric acid
these stones are
comprised of mg ammonium phosphate,
account for <15% of stones in us & 30% worldwide,
more common in women, & associated with infex?
struvite aka staghorn
these stones account for 1% of stones in adults, 8% in kids
& are genetically determined?
cystine, also staghorn or multiple stones
these stones are extremely rare & are result of genetic disorder
xanthine
what kind of pain does pt present with?
flank, back, abdomen, scrotum/labia & it is sudden/severe w/ urgency/frequency to urinate
What are other constitutional symptoms?
nausea, vomiting
fever may/may not be present
how does hematuria present?
gross or microscopic
how is bp & pulse?
elevated & increased
is cva present?
yes, tender
facilitation happens at what spinal level?
T10-L1
what other illnesses in the kidney mimic renal lithiasis?
pyelonephritis, nephritis, renal abscess, renal infarction, renal vein thrombosis, renal tumor, hydronephrosis due to obstruction, iatrogenic (nephrostomy tube), blood clot, sickle cell in renal pelvis
What other illnesses not in the kidney mimic renal lithiasis?
muscle spasm (psoas & quadratus lumborum), aortic aneurysm, rib dysfunction, fractures, lower lobe pneumonia, pleuritic, appendicitis, abdominal/pelvic tumor, endometriosis, tubal pregnancy, prostatic hypertrophy, iatrogenic (clips), herpes zoster
calcium supplementation
yes, can increase calciuria
decreased water intake
yes, leads to supersaturation of urine
increased soda consumption
yes, increase na & sucrose load
high protein diet
yes, increases uric acid & ca excretion & decreased citrate excretion
high sodium diet
yes, increases calcium excretion
fructose, sucrose, xylitol
yes, increases ca excretion
aspartame
no
eating lots of spinach, peanut butter, vitamin c supplementation
yes, increases oxalate excretion
eating lots of citrus fruits
no, increases citrate excretion which makes calcium more soluble
gout
yes, associated with high uric acid levels
htn
we don’t know, these 2 commonly occur together however
diabetes milletus & metabolic syndrome
yes, associated w/ high uric acid levels
immobility
yes, associated with high calcium levels
medullary sponge kidney, renal tubular acidosis, & kidney failure
yes, associated with high calciuria & low urinary citrate
hypothyroidism
yes. decreased gfr –> increase in vasopressin –> decrease in urine production –> supersaturated urine
hyperparathyroidism & elevated vitamin d
yes. hypercalcemia –> hypercalciuria
seizure disorder
no
uti
yes, lowers urinary citrate and causes struvite stones
gastric bypass surgery
yes. short gut syndrome. increase oxalate uptake & excretion
chronic diarrhea
increase oxalate uptake & excretion, lowers urinary citrate
fasting & binge drinking
associated w/ high uric acid levels
cancer
no, but drugs used to tx lymphoma, leukemia, multiple myeloma can cause stones
furosemide, acetazolamide, mg antacids, glucocorticoids, theophyline
increase calcium oxalate stones
Aspirin, hydrochlorthiazide, probenecid
uric acid stones
topiramate
no; increases urinary pH & decreases urinary citrate
testosterone
no increases urinary oxalate excretion
laxatives
no. promote supersaturation of ammonium & urates
ephedrine, tmp/smx (trimethoprim/sulphamethoxazole), ciproflaxin, triamterene, acyclovir, indinavir
no, drug crystallizes out of urine
what are other additional risk factors to renal lithiasis?
obesity, weight gain, living in warmer climate, family hx/genetics, tea/soda consumption, antibiotic use/altered microbiome, glysphosphate exposure (roundup)
what kind of immediate lab studies are done when suspecting a kidney stone?
u/a w/ microscopy, u/a culture & sensitivity (C&S), Na, K, Cl, CO2, calcium, creatinine/bun, uric acid, random blood sugar level, cbc
what lab studies should you order later?
stone analysis ,tsh, pth, vitamin D level, 24 hour urinalysis
look at slide for pictures of crystals
these are calcium oxalate stone
calcium oxalate dihydrate crystals are bipyramidally shaped
hexagonal cystine crystals are hexagonally shaped
What is the gold standard radiological studies that should be done?
helical ct w/o contrast
(not good for children, teens or pts with frequent stones due to radiation exposure)
It is done without contrast because contrast obscures stones & if the kidney is already injured, contrast will ruin ir further)
what is the second line of radiological studies?
kub x ray
what is the third line of radiological studies
u/s of abdomen (good for kids & determines if other organs affected)
how should you treat a stone that is bigger than 6 mm & less than 10 in the renal pelvis or staghorn?
percutaneous nephrostomy/nephrolithotomy or extracorporeal shockwave lithotripsy
how do you tx a stone that is in the ureter & not passing?
endoscopic cystoscopy to retrieve stone
how do you tx a young child with a stone
postural therapy w/ hydration, percussion in trendelenburg position
how do you tx a kidney that is barely functioning?
nephrectomy
how do you tx if ther are remaining fragments from struvite calculi
oral chemolysis w/ acetohydroxamic acid & suppressive antibiotic tx
