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stone disease Flashcards

1
Q

what are most stones made out of?

A

CA

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2
Q

what stones are radioopaque?

A

Ca

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3
Q

most important factors for urinary stone development?

A

high protein,
high salt
inadequate hydration

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4
Q

acidic urine makes what kind of stones?

A

uric acid or cystine stones

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5
Q

alkaline urine produces stones how?

A

contributes to UTI prodoucing (proteus, klebsiella) making struvite stones

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6
Q

what is the MC stone?

A

calcium oxalate stones

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7
Q

what is the strongest promoter of stone formation?

A

urinary oxalate

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8
Q

what are the two causes of increased oxalate?

A

not enough calicium in the gut or >2 g/day ascorbic acid (vit C)

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9
Q

what helps prevent calcium phosphate and calcium oxalate crystallization?

A

increased urinary citrate that binds w/ calcium and doesnt allow stone formation. there is more citrate in alkalotic urine

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10
Q

what are risks for calcium oxalate and calcium phosphate stones?

A

high sodium, high animal protein diet, dehydration, hypercalciuria, low urine citrate

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11
Q

what causes struvite stones?

A

MC women w/ recurrent URIs w/ urease producing bacteria

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12
Q

what are struvite stones?

A

magnesium-ammonium-phosphate stone

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13
Q

what are urease-producing bacteria?

A

proteus, pseudomonas, providencia, klebsiella, staphylococcus, and mycolplasma

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14
Q

what is the acidity for calcium oxalate stones?

A

> 7.2

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15
Q

what risk does calcium phosphate have that calcium oxalate does not?

A

increased urine alkalinity

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16
Q

stone frequently composed of struvite that’s in the renal pelvis and extends into at least 2 calyces

A

staghorn calculi

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17
Q

what is the only amino acid insoluble in urine?

A

cystine

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18
Q

what pH do cystine and uric acid stones form in?

A

pH <5.5

19
Q

what stones are radioopaque?

A

struvite

calcium

20
Q

what stones are radiolucent?

A

cystine

uric acid stones

21
Q

what increases the risk of uric acid stones?

A

think people that have malignancy or are undergoing malignancy treatment

myeloproliferative disorders

22
Q

clinical findings of stones?

A

colic pain: obstructing

sudden (may awaken from sleep)
severe, unremitting flank pain
\+/- N/V
constantly moving around looking for comfort
hematuria
CVA tenderness
pain may refer as it moves down ureter
23
Q

if the stone is lodged at the ureterovesical junction what are the symptoms?

A

marked urinary urgency and frequency

24
Q

what pH will you see calcium phophate stones?

A

> 7.5

25
Q

what is the gold standard imaging for stones?

A

non contrast CT

26
Q

What imaging for stones if the patient is pregnant?

A

Renal US

27
Q

What is the “standard of care” imaging for stones for a pregnant woman?

A

Non-contrast CT

28
Q

Asymptomatic stone treatment w/ no signs of infection?

A

Nothing

29
Q

What size stones will pass spontaneously?

A

<= 5-6 mm

30
Q

What is acute treatment for stones?

A

Hydration: oral first then IV

Medications: analgesics (NSAID, but be careful because if they are taking an ACEI in scenario it will be evident that it is safe to use an NSAID if not then use narcotics), anti-emetic, alpha blocker

31
Q

What patients would you refer for stones?

A 
Infection (bacteremia, sepsis)
Obstruction
Intractable pain (admit and control)
N/V
Stone size >=6mm
Fails to pass w/in 4 weeks
Pregnant
Immunocompromised 
Fail to pass in 4 weeks
32
Q

Who gets emergent urologic evaulation and drainage?

A

Obstructive urinary calculi w/ fever and infected urine

33
Q

What works well on stones in the renal pelvis or upper 2/3 of ureter and size <1.5 cm?

A

Extracorporeal Shock wave lithotripsy: DISCONTINUE NSAIDS 3 DAYS PRIOR BECAUSE OF BLEEDING

34
Q

What can be placed following ESWL to facilitate passage of stones?

A

Ureteral stent

35
Q

What is good for stone removal in lower 1/3 of ureter?

A

Ureteroscopic stone extraction

36
Q

What is good for stones in renal collecting system, upper 2/3 of ureter, and >2cm?

A

Percutaneous nephrolithotomy

37
Q

What can be used to remove stones in patients w/

1. Complex anatomy
2. Obstruction
3. Large infected struvite stones?
I think he said stag horn or pregnant in review?

A

Open stone surgery

38
Q

When is imaging maybe unnecessary for stones?

A

Recurrent

39
Q

What is the bottom line treatment for acute stone treatment?

A

Fluids
Pain control
Confirm stone
Admit (failure to control pain, infection, comorbidity)
Refer: (infection, large stone, comorbidity)

40
Q

What are the labs for recurrent stones?

A

24 hr. Urine collection assess:

  • total volume
  • pH
  • Urinary excretion of Ca, oxalate, citrate, sodium potassium and creatinine

Serum PTH, Uric acid r/o primary hyperparathyroidism or gout

41
Q

What are prevention measures for stones?

A

Decrease salt

Decrease animal product

DO NOT RESTRICT CA

increase Bran and water

Avoid soda (high phosphate)

Avoid Vit C (ascorbic acid metabolism- inc. oxalate)

Decrease dietary oxalate

42
Q

Treatment for recurrent stones?

A 
If high calcium
Thiazide diuretics (HCTZ, chlorthalidone)

If low urinary citrate or low urine pH
Potassium citrate therapy
Citrate inc for Ca
Raise pH in uric acid or cystine stone formers

43
Q

How much should a patient urinate daily?

A

1.5-2 L/day

44
Q

What is the f/u for stones?

A

Chronic:
Repeat 24 hr urine in 6 months

Repeat stone analysis if interventions are failing

Consider yearly CT to assess for new formation

GU (19 decks)

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