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Renal II > Renal Lithiasis > Flashcards

Renal Lithiasis Flashcards

1
Q

Who is more prone?

A

males > females

whites>hispanics>blacks

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2
Q

why does the incidence of kidney stones seem to be increasing?

A

becuase of rise in metabolic syndrome in us population

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3
Q

what population has shown the highest increase in kidney stones?

A

children, particularly black female (teens)

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4
Q

what is a typical pt for a kidney stone?

A

white male in his 30s to 40s

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5
Q

what kind of stone accounts for 80% of stones, usually paired w/ oxalate, radio-opaque?

A

calcium stones

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6
Q

these stones account for <10% of stones

A

uric acid

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7
Q

these stones are
comprised of mg ammonium phosphate,

account for <15% of stones in us & 30% worldwide,

more common in women, & associated with infex?

A

struvite aka staghorn

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8
Q

these stones account for 1% of stones in adults, 8% in kids

& are genetically determined?

A

cystine, also staghorn or multiple stones

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9
Q

these stones are extremely rare & are result of genetic disorder

A

xanthine

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10
Q

what kind of pain does pt present with?

A

flank, back, abdomen, scrotum/labia & it is sudden/severe w/ urgency/frequency to urinate

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11
Q

What are other constitutional symptoms?

A

nausea, vomiting

fever may/may not be present

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12
Q

how does hematuria present?

A

gross or microscopic

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13
Q

how is bp & pulse?

A

elevated & increased

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14
Q

is cva present?

A

yes, tender

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15
Q

facilitation happens at what spinal level?

A

T10-L1

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16
Q

what other illnesses in the kidney mimic renal lithiasis?

A

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

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17
Q

What other illnesses not in the kidney mimic renal lithiasis?

A

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

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18
Q

calcium supplementation

A

yes, can increase calciuria

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19
Q

decreased water intake

A

yes, leads to supersaturation of urine

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20
Q

increased soda consumption

A

yes, increase na & sucrose load

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21
Q

high protein diet

A

yes, increases uric acid & ca excretion & decreased citrate excretion

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22
Q

high sodium diet

A

yes, increases calcium excretion

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23
Q

fructose, sucrose, xylitol

A

yes, increases ca excretion

24
Q

aspartame

A

no

25
Q

eating lots of spinach, peanut butter, vitamin c supplementation

A

yes, increases oxalate excretion

26
Q

eating lots of citrus fruits

A

no, increases citrate excretion which makes calcium more soluble

27
Q

gout

A

yes, associated with high uric acid levels

28
Q

htn

A

we don’t know, these 2 commonly occur together however

29
Q

diabetes milletus & metabolic syndrome

A

yes, associated w/ high uric acid levels

30
Q

immobility

A

yes, associated with high calcium levels

31
Q

medullary sponge kidney, renal tubular acidosis, & kidney failure

A

yes, associated with high calciuria & low urinary citrate

32
Q

hypothyroidism

A

yes. decreased gfr –> increase in vasopressin –> decrease in urine production –> supersaturated urine

33
Q

hyperparathyroidism & elevated vitamin d

A

yes. hypercalcemia –> hypercalciuria

34
Q

seizure disorder

A

no

35
Q

uti

A

yes, lowers urinary citrate and causes struvite stones

36
Q

gastric bypass surgery

A

yes. short gut syndrome. increase oxalate uptake & excretion

37
Q

chronic diarrhea

A

increase oxalate uptake & excretion, lowers urinary citrate

38
Q

fasting & binge drinking

A

associated w/ high uric acid levels

39
Q

cancer

A

no, but drugs used to tx lymphoma, leukemia, multiple myeloma can cause stones

40
Q

furosemide, acetazolamide, mg antacids, glucocorticoids, theophyline

A

increase calcium oxalate stones

41
Q

Aspirin, hydrochlorthiazide, probenecid

A

uric acid stones

42
Q

topiramate

A

no; increases urinary pH & decreases urinary citrate

43
Q

testosterone

A

no increases urinary oxalate excretion

44
Q

laxatives

A

no. promote supersaturation of ammonium & urates

45
Q

ephedrine, tmp/smx (trimethoprim/sulphamethoxazole), ciproflaxin, triamterene, acyclovir, indinavir

A

no, drug crystallizes out of urine

46
Q

what are other additional risk factors to renal lithiasis?

A

obesity, weight gain, living in warmer climate, family hx/genetics, tea/soda consumption, antibiotic use/altered microbiome, glysphosphate exposure (roundup)

47
Q

what kind of immediate lab studies are done when suspecting a kidney stone?

A

u/a w/ microscopy, u/a culture & sensitivity (C&S), Na, K, Cl, CO2, calcium, creatinine/bun, uric acid, random blood sugar level, cbc

48
Q

what lab studies should you order later?

A

stone analysis ,tsh, pth, vitamin D level, 24 hour urinalysis

49
Q

look at slide for pictures of crystals

A

these are calcium oxalate stone

calcium oxalate dihydrate crystals are bipyramidally shaped

hexagonal cystine crystals are hexagonally shaped

50
Q

What is the gold standard radiological studies that should be done?

A

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)

51
Q

what is the second line of radiological studies?

A

kub x ray

52
Q

what is the third line of radiological studies

A

u/s of abdomen (good for kids & determines if other organs affected)

53
Q

how should you treat a stone that is bigger than 6 mm & less than 10 in the renal pelvis or staghorn?

A

percutaneous nephrostomy/nephrolithotomy or extracorporeal shockwave lithotripsy

54
Q

how do you tx a stone that is in the ureter & not passing?

A

endoscopic cystoscopy to retrieve stone

55
Q

how do you tx a young child with a stone

A

postural therapy w/ hydration, percussion in trendelenburg position

56
Q

how do you tx a kidney that is barely functioning?

A

nephrectomy

57
Q

how do you tx if ther are remaining fragments from struvite calculi

A

oral chemolysis w/ acetohydroxamic acid & suppressive antibiotic tx

Renal II (2 decks)

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