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Renal > SM 216 Kidney Stones > Flashcards

SM 216 Kidney Stones Flashcards

1
Q

How common are kidney stones?

A

Effect 1 in 10 people

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2
Q

Who gets kidney stones more often?

A

Men > Women, Asians and Caucasians, Stone Belt in the US

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3
Q

How does climate effect Kidney Stones?

A

Hot and dry climates promote water loss which facilitates kidney stone formation

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4
Q

What is supersaturation?

A

Supersaturation describes the process of crystal formation after the concentration of a substance improves the solubility threshold in solution, leading to precipitation out of solution and crystal formation

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5
Q

What is a stone nidus?

A

A stone nidus is a solid particle that facilitates crystal formation of other particles

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6
Q

What are the main determinants of solubility, and which ones are physiologically relevant?

A

Concentration of ion/compound, pH, and temperature

Temperature cannot be varied, so concentration’s of ions and pH are the physiologically relevant determinants

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7
Q

How does urinary pH effect the relative solubility of molecules?

A

High urinary pH increases the solubility of some molecules and decreases the solubility of others

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8
Q

Does high or low solubility of a substance facilitate stone formation?

A

Low solubility facilitates stone formation

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9
Q

Which solutes have a higher solubility at high urinary pH?

A

Cysteine and Uric acid, which are more likely to form stones at lower pH

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10
Q

Which solutes have a lower solubility at high urinary pH?

A

Ammonium Urate and Phosphate

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11
Q

Which molecules are more likely to form stones at low urinary pH?

A

Uric acid and Cysteine, because they have higher solubility at high pH

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12
Q

Which molecules are more likely to form stones at high urinary pH?

A

Ammonium Urate and Phosphate, because they have lower solubility at high pH

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13
Q

Which stones look like “square envelopes”?

A

Calcium oxalate

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14
Q

What is the most common type of kidney stone?

A

Calcium oxalate

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15
Q

What is the second most common type of kidney stone?

A

Calcium phosphate

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16
Q

What are the risk factors for calcium stones?

A

Hypercalciuria, Hyperoxaluria

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17
Q

What is the main risk factor for calcium stone?

A

Hypercalciuria

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18
Q

What can cause hypercalciuria?

A

Hypercalcemia (high serum Ca leads to high urine Ca)
Due to: hyperparathyroidism, malignancy, Vit D toxicity

May be idiopathic

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19
Q

Where can hyperoxaluria come from?

A

Dietary intake of high-oxalate food, Vit C intake, and low calcium intake

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20
Q

Why is Crohn’s disease a risk for hyperoxaluria?

A

Malabsorption in GI tract leads to increased oxalate reabsorption

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21
Q

How does low Calcium intake lead to hyperoxaluria?

A

Ca normally binds oxalate leading to less systemic absorption, so low calcium lowers oxalate sequestration and leads to more absorption, causing hyperoxaluria

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22
Q

What kind of stone appears as “coffin lids”?

A

Struvite stones (infection stones)

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23
Q

What makes up Struvite stones?

A

Magnesium ammonium phosphate

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24
Q

What are the risk factors for Struvite stones?

A

Alkalization of urine due to urease producing bacteria, which lowers the solubility of urinary phosphate-cation (Mg/Ca/NH4) complexes

25
Q

Which bacteria is associated with Struvite stones?

A

Proteus spp

26
Q

What are Staghorn calculi?

A

Very large Struvite stones that include more than one renal calyx, often due to Proteus spp

27
Q

What type of stones show up as diamonds or rhomboids?

A

Uric acid stones appear as diamond or rhomboid stones

28
Q

Which type of stones do now show up on X-Ray?

A

Uric Acid stones

29
Q

What pH promotes Uric acid stones?

A

Acidic urine, which lowers the solubility of uric acid

30
Q

What pH promotes Struvate stones?

A

Basic urine, which lowers the solubility of phosphate

31
Q

What are the risk factors of Uric acid stones?

A

Hyperuricosuria, low urinary pH

32
Q

What causes hyperuricosuria?

A

Dietary intake of purines and animal protein

High cell-turnover states which release uric acid

33
Q

What are high cell turn-over states?

A

Hemolysis, tumor-lysis syndrome = rapidly dying cells release uric acid

34
Q

What type of stones appear “hexagonal”?

A

Cysteine stones are hexagonal

35
Q

What causes cysteine stones?

A

Cysteine stones are secondary to inherited disorders of metabolism, because patients can’t reabsorb Cysteine, raising concentration in the urine

36
Q

What is the treatment for Cysteine stones?

A

Cysteine is insoluble at low pH, so treatment is alkalinizing the urine

37
Q

What are general risk factors for stone formation?

A

Low urine volume
High Na diet
Hypocitraturia
High protein diet

38
Q

Does low or high urine volume favor stone formation?

A

Low urine volume - raises the conc. of solutes which increase the probability of stone formation

39
Q

How does high Na favor stone formation?

A

High Na diets result in high urinary Ca due to Na/Ca reabsorption in the PCT

40
Q

How does hypocitraturia favor stone formation?

A

Citrate normally chelates ions and prevents stone formation with phosphate

41
Q

How does a high protein diet favor stone formation?

A

High protein diets increase the acid load, which results in bone resorption since bone is a major buffer, raising calcium levels in serum and urine, favoring stones formation

42
Q

What unexpected organ is a major buffer source?

A

The bone, at the cost of raising serum and urinary calcium

43
Q

How does urinary flow effect stone formation?

A

High flow = less stone formation

Low flow = more stone formation

44
Q

How do bacteria effect stone formation?

A 
Sterile = less stone formation
Infected = more stone formation
45
Q

How does fluid intake effect stone formation?

A

High fluid intake correlates with lower risk of stone formation, especially above 2L/day

46
Q

What is renal colic?

A

Renal colic is the acute presentation of kidney stones

47
Q

How do kidney stones present?

A

Flank pain radiating to the groin
Extremely painful
No comfortable position
Hematuria

48
Q

Do kidney stones cause hematuria?

A

Yes, both gross and microscopic

49
Q

How are kidney stones differentiated from peritonitis?

A

Kidney stones do not have a position of comfort, while peritonitis does

50
Q

How painful are kidney stones?

A

Kidney stones are on par with childbirth

51
Q

What is the recommended way to diagnose kidney stones?

A

Non-contrast CT abdominal scan

Uric acid stones don’t show up on X Ray

52
Q

What is the major determinant of whether or not a kidney stone will pass?

A

Stone size is the major determinant; stones < 5mm will likely pass on their own

53
Q

Why might a kidney stone be treated instead of being allowed to pass?

A

Too large > 5mm
Pain control
Concurrent urinary/kidney infection or injury

54
Q

What intervention can treat large kidney stones?

A

Extracorporeal shock-wave lithotripsy

55
Q

What factor predisposes recurrent kidney stones?

A

Having a kidney stone predisposes another kidney stone

56
Q

How are kidney stones managed long term?

A

24 hour urine collections for calcium, oxalate, sodium, uric acid, citrate, phosphate, pH to identify major risk factors for medical intervention

57
Q

What are potential medical interventions for kidney stones?

A

Reduce hypercalciuria
Increase urinary pH and citrate
Assess medication list and address risk

58
Q

How can hypercalciuria be treated?

A

Thiazide diuretics - stimulate calcium reabsorption at the DCT

59
Q

What can increase urinary pH and citrate?

A

Potassium citrate supplementation - as part of kidney stone treatment

Renal (19 decks)

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