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SM_216a: Kidney Stones Flashcards

1
Q

Describe the epidemiology of kidney stones

A

Epidemiology of kidney stones

  • Common
  • Higher prevalence in men
  • Many have recurrence
  • Higher risk in Asians and Caucasians, stone belt in U.S.
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2
Q

Pathogenesis of kidney stones is related to the chemical property _____

A

Pathogenesis of kidney stones is related to the chemical property solubility

  • Determined by concentration of ions/compound, pH, and temperature
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3
Q

Describe the pathogenesis of kidney stones

A

Pathogenesis of kidney stones

  1. Concentration of substance exceeds solubility threshold
  2. Supersaturation
  3. Precipitation out of solution
  4. Crystal formation
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4
Q

Crystal formation of kidney stones occurs more quickly when _____

A

Crystal formation of kidney stones occurs more quickly when other solid particles exist in solution on which precipitation can occur (stone nidus)

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5
Q

Acidic urine pH promotes formation of ____ and ____ kidney stones

A

Acidic pH promotes formation of cystine and uric acid kidney stones

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6
Q

Basic urine pH promotes formation of ____ and ____ containing kidney stones

A

Basic urine pH promotes formation of Ca and P containing kidney stones

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7
Q

____ are the most common kidney stone in the U.S.

A

Calcium-containing stones are the most common kidney stone in the U.S.

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8
Q

Calcium containing stones include _____ and _____

A

Calcium containing stones include calcium oxalate and calcium phosphate

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9
Q

Calcium oxalate stones resemble _____

A

Calcium oxalate stones resemble square envelopes

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10
Q

Risk factors for calcium stones are _____ and _____

A

Risk factors for calcium stones are hypercalcuria and hyperoxaluria

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11
Q

Describe how causes of hypercalcuria are a risk factor for calcium stones

A

Hypercalcuria as a risk factor for calcium stones

  • Secondary to hypercalcemia: increased serum Ca levels -> increased urinary Ca
  • Idiopathic: serum Ca normal but urinary Ca elevated
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12
Q

Describe how causes of hyperoxaluria are a risk factor for calcium stones

A

Hyperoxaluria as a risk factor for calcium stones

  • Dietary intake of high oxalate foods
  • Vitamin C intake: ascorbic acid metabolized to oxalate
  • Malabsorption in GI tract: leads to increased oxalate reabsorption
  • Low calcium intake: less Ca to bind oxalate -> more systemic oxalate absorption -> increased urinary oxalate
  • Primary hyperoxalosis
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13
Q

Struvite kidney stones result from _____ and are composed of _____ and _____

A

Struvite kidney stones result from infection and are composed of magnesium ammonium phosphate and calcium carbonate apatite (triple phosphate)

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14
Q

Struvite kidney stones resemble _____

A

Struvite kidney stones resemble coffin lids

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15
Q

Describe the pathogenesis of struvite kidney stones

A

Pathogenesis of struvite kidney stones

  1. Urease-producing bacteria, such as Proteus, alkalinize the urine
  2. Urinary phosphate becomes insoluble
  3. Urinary phosphate complexes with surrounding ions (Mg, Ca, NH4+)
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16
Q

_____ are large struvite kidney stones that include more than one renal calyx

A

Staghorn calculi are large struvite kidney stones that include more than one renal calyx

17
Q

Uric acid kidney stones have a ______ shape

A

Uric acid kidney stones have a diamond/rhomboid shape

18
Q

Uric acid kidney stones are _____ on x-ray in contrast to other types of stones

A

Uric acid kidney stones are radiolucent (transparent) on x-ray in contrast to other types of stones

19
Q

Uric acid is _____ in acidic urine, so there is a _____ risk of forming a stone in acidic urine

A

Uric acid is very insoluble in acidic urine, so there is a high risk of forming a stone in acidic urine

20
Q

Risk factors for uric acid kidney stones are _____ and _____

A

Risk factors for uric acid kidney stones are hyperuricosuria and low urinary pH

  • Hyperuricosuria: dietary intake of purines and animal protein; high cell turnover states -> hyperuricemia -> hyperuricosuria
21
Q

Cysteine kidney stones have a _____ shape

A

Cysteine kidney stones have a hexagonal shape

22
Q

Cysteine stones are _____ and form secondary to _____

A

Cysteine stones are rare and form secondary to inherited disorder of metabolism

23
Q

Treatment for cysteine kidney stones includes ____ urine

A

Treatment for cysteine kidney stones includes alkalinizing urine

(very insoluble at low pH)

24
Q

General risk factors for stone formation are _____, _____, _____, and _____

A

General risk factors for stone formation are low urine volume, high Na diet, hypocitraturia, and high protein diet

25
Q

High Na diet is a risk factor for stone formation because it causes ______

A

High Na diet is a general risk factor for stone formation because it causes increased urinary Ca levels

26
Q

Hypocitraturia is a general risk factor for stone formation because citrate _____

A

Hypocitraturia is a general risk factor for stone formation because citrate inhibits stone formation

27
Q

High protein diet is a general risk factor for stone formation because _______

A

High protein diet is a general risk factor for stone formation because

  1. Protein metabolism results in an overall acid load
  2. Bone is a major source of buffer
  3. Ca resorption from bone and eventual increase in urinary levels
28
Q

Proper _____ intake prevents kidney stones

A

Proper fluid intake prevents kidney stones

29
Q

Kidney stones present acutely as ______ and are diagnosed via ______

A

Kidney stones present acutely as renal colic and are diagnosed via non-contrast CT abdomen

  • Flank pain, RLQ, or LLQ abdominal pain radiating to groin
  • Extremely painful
  • Cannot find a comfortable position
  • Hematuria is common
30
Q

Kidney stones _____ in size will pass

A

Kidney stones < 5 mm in size will pass

31
Q

Describe acute treatment for kidney stones

A

Acute treatment for kidney stones

  • Pain control
  • Urrgent intervention with extracorporeal shock wave lithotripsy or percutaneous nephrolithotomy if concurrent urinary / kidney infection or AKI
32
Q

Medical interventions for kidney stones include ____, ____, and ____

A

Medical interventions for kidney stones include

  • Reducing hypercalcuria via thiazide diuretic
  • Increasing urinary pH and citrate via citrate supplementation
  • Addressing risk from existing medications: loop diuretics, Ca, Vitamin D, Vitamin C, some HIV meds like indinavir
33
Q

General management of kidney stones includes _____, _____, _____, _____, and _____

A

General management of kidney stones includes urine volume > 2.0 L/day, normal Ca intake, limiting salt intake, limiting animal protein, normal BMI, and adequate physical activity

Renal (31 decks)

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