Review: Kidney Stones

Question 1

5 types of kidney stones

Answer 1

calcium/oxalate or phosphate
uric acid stones
struvite stones
cysteine stones
xanthine stones

Question 2

II: uric acid stones: risk

Answer 2

gout, hyperuricemia, glycogen storage disease, GI disorders, meds like probenecid and aspirin

Question 3

II: uric acid stones: meds

Answer 3

like allopurinol that decrease uric acid production are helpful

Question 4

II: uric acid stones: protein

Answer 4

low pro/purine diet

Question 5

II: uric acid stones: supps

Answer 5

citrate or bicarb supps to make urine more alkaline

Question 6

II: uric acid stones: LNS

Answer 6

Lesch-Nyhan Syndrome: hereditary def of enzyme hypocanthine-guanine phosphoribosyltransferase (HPRT), which leads to excess uric acid synthesis from purines

Question 7

Lesch-Nyhan Syndrome s/s

Answer 7

self-mutilation, orange urate crystals in joints, kidneys, CNS.
kidney stones, hematuria, join swelling, dysphagia, vomit, irritability, compulsion, hypotonia, athetosis, chorea, moderate mental retardation, megaloblastic anemia,

Question 8

Lesch-Nyhan Syndrome onset

Answer 8

infancy, more in males as it is X linked

Question 9

Lesch-Nyhan Syndrome med

Answer 9

allopurinol therapy may help prolong life 30-40 years

Question 10

III: struvite stones

Answer 10

magnesium-ammonium-phosphate

Question 11

III: struvite stones: associated w/

Answer 11

UTI’s such as proteus, Pseudomonas, or Klebsiella

Question 12

III: struvite stones: may cause

Answer 12

staghorn calculi - will need surgery

Question 13

III: struvite stones: Mgmt

Answer 13

antibiotics

acetohydroxamic acid inhibits urease - effective but GI side effects

Question 14

IV: cysteine stones

Answer 14

cysteine stones in kidney, ureter, and bladder. difficult to manage often leads to kidney damage

Question 15

IV: cysteine stones: genetic

Answer 15

abnormality of abnormal transport of AAs in kidney causing high levels of cysteine in urine to form stones

Question 16

IV: cysteine stones: mgmt

Answer 16

high fluid intake to keep urine at 4000 ml/day.
diet to keep urine alkaline.
protein and methionine restriction?

Question 17

IV: cysteine stones: meds

Answer 17

potassium citrate

penicillamine therapy

Question 18

V: xanthine stones

Answer 18

hereditary lack of xanthine DH

Question 19

V: xanthine stones s/s

Answer 19

kidney stones, CKD, joint pain, myopathy

Question 20

V: xanthine stones diet mgmt

Answer 20

high fluid intake, avoid purines (high purine foods: meat, organs, peas, beans, spinach, lentils), low protein diet

Question 21

acid ash foods

Answer 21

meat, whole grains, egg, cheese, prunes, plums, cranberries

Question 22

alkaline ash foods

Answer 22

milk, F&V