Stone Flashcards
what is solubility product?
what is formation product?
concentration at the point of saturation
concentration when the salt can no longer be held in solution
Stone crystals Ca Ox monohydrate Ca Ox dihydrate Ca PO4 Cystine
dumbbell
envelope
prisms
hexagonal
__% of ingested oxalate is absorbed
__% of absorbed oxalate is excreted in urine
__% of urinary oxalate comes from diet
10%
Almost all
30%
what is primary oxaluria?
AR
preferential oxidative conversion of glyoxylate to oxalate
what is elevated in primary oxaluria II and III?
II: L-glyceric acid
III: HOG
pKa of uric acid
5.5 (50% soluble)
pKa of cystine
8.3
First time stone former
10y risk of recurrence
52% (Uribarri)
Associations with type 1 RTA
Sjogren
Autoimmune thyroiditis
Drugs
Diagnostic test for type 1 RTA?
Ammonium chloride loading test: urine pH >5.5
Cutoff for a positive cyanide-nitroprusside test
> 75mg/L
FP for cyanide-nitroprusside test
homocystinuria
acetonuria
drugs (sulpha, N-acetylcysteine)
__mEq of oral Na = __mg of urinary Ca
100 mEq
50 mg
Cystinuria: limit ____-rich food
Methionine
Borghi diet
___Ca
___Salt
___Protein
30mmol
50mmol
52g
SE of thiazide
Hypo: K, Mg, citrate, vol
Hyper: uricosuria, glycemia
Medical treatment for Ca Ox stone former with hyperuricosuria and normalcalciuria
Allopurinol
K citrate
Conversion for K citrate
__ mEq = __ mg
10 mEq = 1080 mg
1 mEq ~= 100 mg
what is Thiola and SE
a-mercaptopropionylglycine
proteinuria, liver impairment, hematological
what is Reloxaliase?
recombinant oxalate decarboxylase
Bacilus subtilis
converts oxalate to formate and CO2
what is Lumasiran?
liver-directed small interfering RNA
degrades mRNA that encodes glycolate oxidase
reduces glyoxylate production
what does Cochrane review tell us about MET? 2018
Overal RR 1.16
< 5mm RR 1.06
> 5mm RR 1.45
Shorter expulsion time (3.4d), hospitalization, analgesic use
Not affected by stone location / a-blocker type
what does Sam Mcclinton tell us about RIRS vs ESWL in stones < 2cm?
< 1cm: RR 1.1
1 - 2cm: RR 1.5
Calyceal diverticula
Definition
non-secretory outpouching of the collecting system
Calyceal diverticula
More common at ___ pole
Classified into: ___
Upper pole
Type I: polar, minor calyx
Type II: midzone, major calyx/renal pelvis
Intracorporeal lithotripsy techniques
EHL USG Pneumatic Laser Combination
What is LASER?
What is Holmium laser?
Light amplification by stimulated emission of radiation
Holmium ytrium aluminium garnet laser
Traxer in vitro definition of a dust
<= 250 um
3 criteria
what if TFL?
laser pumping: electronically modulated diode laser
thulium-doped silica fiber as gain medium
what is post-ureteroscopic lesion scale?
Grade 0 to 5
Mechanisms of ureteric avulsion (URS)
Stone basket
Entrapment (scabbard, bunching of distal rubber, steinstrasse, locked deflection)
how long is Alken central rod?
58cm
Amplatz: made of __
polyurethane
fURS : T / F
Reusable: fiberoptic or digital
Fiberoptic fURS has smaller width
Fiberoptic fURS has smaller working channel
T (disposable = all digital) T F (same = 3.6Fr)
Extracorporal lithotripsy techniques
EHL
Piezoelectric
Electromagnetic
Electroconductive
Describe a shockwave pressure profile
Shorter positive peak
Longer negative trough
how to improve ESWl success rate?
Patient selection
Optimize SW delivery: 4
Analgesia
Fragment passage
what is biofilm?
what layers are there?
linking, base, surface films
what is nephrocalcinosis?
what types are there?
Generalized
Medullary (98%), cortical
Characteristic imaging findings of papillary necrosis
Papillary type: lobster claw
Medullary type: ball on tee
What is medullary sponge kidney?
developmental defect of collecting system
cystic dilatation of distal collecting ducts
Medullary sponge kidney
___% bilateral
Associated with ___
__ gene implicated
75%
BWS
RET oncogene
Medullary sponge kidney: imaging findings
Bunch of grapes
Paint-brush appearance
