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Met 3b > Renal stone disease > Flashcards

Renal stone disease Flashcards

1
Q

Magnesium ammonium phosphate

A

Struvite stones
Form staghorn stones
Infection with urease producing bacteria

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2
Q

Clinical features of patients with calculi- Renal

A

Pain (loin)
Haematuria (microscopic, or, rarely, macroscopic)
Recurrent UTI (struvite stones)
Malaise, weakness, loss of appetite

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3
Q

Clinical features of patients with calculi- Ureteric

A

Ureteric colic- loin to groin pain
Haematuria (microscopic usually)
Fever (suspect infection proximal to stone)

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4
Q

Clinical features of patients with calculi- Bladder

A 
Suprapubic pain
Haematuria
Urgency + urge incontinence
Recurrent UTI
LUTS
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5
Q

CT-KUB

A

Diagnosis gold standard
99% diagnosed
Not operator dependent
Can give idea of hardness –> what treatments work
Detects= calcium phosphate>calcium oxalate>struvite>cysteine
Doesn’t detect uric acid

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6
Q

X ray KUB

A

Done after CT KUB to assess position

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7
Q

Renal ultrasound

A

Relatively sensitive (75%) for renal calculi and good if radiolucent (e.g. oxalate)
Operator dependent
Imaging modality of choice in pregnant + children

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8
Q

Intravenous Urogram

A

If done well can give size and position
Not used anymore
Small risk death contrast allergy

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9
Q

Tests for underlying conditions that increase stone risk

A

Type 1 RTA- Fasting morning urine=>5.5
Primary hyperparathyroidism= high PTH, adenoma/carcinoma/hyperplasia of thyroid gland
Cysteinuria= cyanide-nitroprusside spot test

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10
Q

Fluid intake

A

Increase fluid intake

–> decreases urine conc of solutes –> moves conc further from formation product

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11
Q

Oxalate

A

Lower oxalate intake
Avoid- rhubarb, spinach, swiss chard, beetroot
Moderate- berries, nuts, seeds, cocoa, choc, soy
Allow- carrots, apples, sprouts, leeks, broccoli, green beans
Meat- high oxalate but also high Ca so cancel each other out

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12
Q

Vitamin C

A

No more than 1 tablet a day

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13
Q

Urate

A

Lower intake

Avoid- meat, shellfish, beer, red wine

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14
Q

Calcium

A

Take calcium with high animal protein meals

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15
Q

Citrate

A

Increase

High fruit diet

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16
Q

Preventative drugs

A 
Thiazides (reduce calciumuria)
Potassium citrate
Sodium bicarb
Allopurinol
Penicillamine
17
Q

Drug treatments

A

Analgesics- NSAIDs- IM 75mg diclofenac
Fluids (if necessary)
Medical expulsive therapy- alpha blockers (Tamsulosin)- relax ureter, but may cause hypotension
Dissolution therapy:
–> urate stones- hydration, urine alkalisation, allopurinol, diet
–> cysteine stones= hydration, urine alkalisation, conversion cysteine to more soluble products

18
Q

Extracorporeal shock wave lithotripsy

A

External application high frequency sound waves to stone
Breaks it up
Most effective stones <2cm + upper pole stones
Don’t do in- pregnancy, lower ureter stones, lower pole stones

19
Q

Semi-rigid ureteroscopy (URS)

A

Telescope passed into ureter
Helps break up stone by laser fragmentation
Good for ureteric stones that don’t respond to ESWL
1st line for ureteric stones in pregnant women

20
Q

Flexible ureterenoscopy

A

Telescope passed into ureter
Helps break up stone by laser fragmentation
Often used when EWSL not successful- large stones, lower pole stones, poor anatomical location of stone
Better than URS for stones higher in ureter as scope more flexible
Lower risk than PCNL

21
Q

Percutaneous nephrolithotomy (PCNL)

A

Incision made in skin where straight telescope can be inserted into urological tract where stone can be broken + fragments removed
Recommended stones >3cm and those that have failed ESWL, FURS + laser
First line staghorn calculi

22
Q

Lower ureteric stone

A

Medial expulsion therapy

If this fails, ESWL or utereroscopy

23
Q

Middle ureteric stone

A

Medial expulsion therapy
ESWL impossible
If problematic, consider ureteroscopy

24
Q

High ureteric stone

A

Medial expulsion therapy low in effectiveness as few alpha receptors
Lithotripsy
Can also consider ureteroscopy, FURS or PCNL

25
Q

Renal stone

A

Small (<5mm) and asymptomatic stones can be observed
Lithotripsy if favourable location in kidney (upper pole) and small size (<2cm)
FURS, PCNL
URS no

26
Q

Acidic urine

A

Urate stone will form

27
Q

Diseases associated with Ca phosphate

A

Hyperparathyroidism
Type 1 RTA
Medullary sponge kidney

28
Q

Causes for underlying predisposition to renal calculi

A 
Hypercalcaemia
Hyperoxaluria
Hypocitraturia
Hyperuricaemia
Tamm-Horsfall protein mutation

Met 3b (21 decks)

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