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Nephro/Uro > Stone Disease > Flashcards

Stone Disease Flashcards

1
Q

Nephrolithiasis

A

general term for renal calculi

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2
Q

Predominant symptom of nephrolithiasis

A

flank pain due to renal colic. (dilation, stretching, spasm)

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3
Q

Physical Exam findings for nephrolithiasis

A 
severe CVA tenderness
pain can migrate to upper/lower ab quadrant (migration of ureteral stone)
abdominal exam unremarkable (hypoactive bowel sounds, absent peritoneal signs)
painful testicles
constant body positional movements
tachycardia
hypertension
microscopic hematuria
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4
Q

Lab Testing for stones

A 
urinary sediment/dipstick test
CBC with diff (febrile pts)
serum electrolytes (vomiting pts)
serum and urinary pH level
microscopic UA
24 hr urine profile
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5
Q

Imaging for stones

A 
noncontrast abdominopelvic CT scan
renal ultrasound
kidney/ureter/bladder xray
IVP
Retrograde pyelography
nuclear renal scanning
plain renal tomography
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6
Q

management goals for stones

A

medical therapy: encourage spontaneous passage of stone. supportive care (pain control/antibiotics)
surgical therapy: completely relieve the obstruction

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7
Q

Medical management for stones

A 
IV hydration
antiemetics
antibiotics
pain control
NSAIDS
uricosuric agents (allopurinol)
antidiuretics
alkalinizing agents
corticosteroids
CCBs
alpha blockers
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8
Q

Surgical management

A

stones greater or equal to 7 mm to pass spontaneously and require some type of surgical procedure: stent placement, percutaneous nephrostomy tube (PNT), extracororeal shockwave lithotripsy, uretoscopy, percutaneous nephrostolithotomy, open nephrostomy

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9
Q

Pathophys of stones

A

supersaturation mechanism: supersaturation of the urine by stone-forming constituents
majority of renal canculi contain calcium
uric acid calculi and crystals of uric acid, with or without other contaminating lens, comprise the bulk of the remaining minority

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10
Q

calcium oxalate, calcium phosphate, and calcium urate are associated with the following disorders

A

hyperparathyroidism
increased gut absorption of calcium
renal calcium leak
renal phosphate leak

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11
Q

etiology of stones

A

low fluid intake
hypercalciuria (most common metabolic abnormality)
magnesium (especially citrate) are important inhibitors of stone formation
4 main chemical types of stones (calcium, struvite, uric acid, cystine)

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12
Q

the most potentially dangerous aspect of stone disease

A

urinary tract obstruction & upper UTI
pyelonephritis, pyonephresis, and urosepsis
necessitates early recognition and immediate surgical drainage

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13
Q

patients at risk of stone development are counseled to seek immediate medical attention if

A

he or she experiences flank or abdominal pain

visible bleed in the urine

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14
Q

regularly visiting a HCP who advises preventative treatment plans can

A
  • improve the situation in most patients with stones
  • strongly motivated to follow a program for maximum kidney stone prophylaxis
  • merely increasing fluid intake and can cut the stone recurrence rate by 60%
  • phenomenon known as the stone clinic effect
  • optimal use of metabolic testing with proper eval and compliance with therapy can completely eliminate new stones in many pts
  • significantly reduces new stone formation in most patients
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15
Q

urologic emergency

A
  • complete urinary tract obstruction
  • obstruction in a solitary kidney
  • obstruction with fever, infection, or both
  • renal failure
  • pain that is uncontrolled with oral meds
  • n/v that causes dehydration
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16
Q

obstructive uropathy can result in

A
  • pain
  • uti
  • loss of renal function
  • urosepsis
  • death
17
Q

urinary obstruction causes/signs/symptoms

A
  • gross or microscopic hematuria
  • altered patterns of micturition
  • acute or chronic renal failure
  • recurrent urinary tract infection
  • new onset or poorly controlled HTN secondary to obstruction and increased renin-angiotensin
  • polycythemia secondary to increased EPO production in the hydronephrotic kidney
  • history of recent gynecologic or ab surgery
18
Q

upper urinary tract

A

kidney and ureter to the hiatus with the bladder

19
Q

lower urinary tract

A

bladder and urethra to the urethral meatus

20
Q

uretopelvic junction

A

ureter connects to kidney

21
Q

ureterovesical junction

A

ureter connects to bladder

22
Q

acute upper urinary tract obstruction symptoms

A
  • flank pain
  • ipsilateral back pain
  • ipsilateral groin pain
  • n/v
  • fever, chills, and dysuria
  • hematuria
23
Q

chronic upper urinary tract obstruction symptoms

A
  • asymptomatic
  • fever, chills, and dysuria,
  • bilateral obstruction or unilateral obstruction in a solitary kidney is sever and renal failure is present, uremia can be present
  • uremia symptoms include weakness, peripheral edema, mental status changes, and pallor
24
Q

lower urinary tract obstruction symptoms

A
  • urgency
  • frequency
  • nocturia
  • incontinence
  • decreased stream
  • hesitancy
  • postvoid dribbling
  • inadequate emptying
  • suprapubic pain or a palpable bladder (urinary retention)
  • dysuria
  • hematuria
  • urethral stricture
  • uterine or bladder prolapse
  • urethral diverticulum
  • prostatic enlargement
25
Q

lab studies for obstruction

A

UA: look for wbcs (infection/inflammation), nitrite, LE
RBCS: microscopic or gross hematuria
Urine pH: stones
Basic Metabolic Panel: Renal insufficiency increased BUN/creatinine, bilateral renal obstruction in a solitary kidney.
hyperkalemia and acidosis may be present
CBC: leukocytosis or anemia

26
Q

imaging studies for obstruction

A 
US
high resolution CT
IVP
MRI
retrograde pyelography
nephrostography
27
Q

treatment: medical therapy for obstruction

A

partial urinary tract obstruction (absence of infection) ca be initially managed with analgesics and prophylactic antibiotics. Antibiotics should cover common urinary tract pathogens. Manage Pain

28
Q

treatment: surgical therapy for obstruction

A

goal is to completely relieve the obstruction. urethral catheter. suprapubic tube/catheter. urethral stent. percutaneous nephrostomy tube

29
Q

Percutaneous nephrostomy tube (PNT)

A

a flexible tube placed through the back directly into the renal pelvis. when ureteral stent cannot be placed cystoscopically in a retrograde fashion.

30
Q

complications of surgical therapy for obstruction

A

cystitis, pyelo, abscess formation, urosepsis, urinary extravasation, urinary fistula formation, renal insufficiency or failure, bladder dysfunction, pain

31
Q

follow up for obstruction

A

after definitive treatment is achieved, final imaging study is obtained to verify complete relief of the obstruction. the type of study performed, as well as the timing of the study, is left to the discretion of the urologist

32
Q

outcome and prognosis of obstruction

A

depend on cause, location, degree, duration, and presence of UTI. worse prognosis the longer the duration, the greater the severity, the presence of concomitant infection.

Nephro/Uro (14 decks)

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