stone disease

Question 1

what are most stones made out of?

Answer 1

CA

Question 2

what stones are radioopaque?

Answer 2

Ca

Question 3

most important factors for urinary stone development?

Answer 3

high protein,
high salt
inadequate hydration

Question 4

acidic urine makes what kind of stones?

Answer 4

uric acid or cystine stones

Question 5

alkaline urine produces stones how?

Answer 5

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

Question 6

what is the MC stone?

Answer 6

calcium oxalate stones

Question 7

what is the strongest promoter of stone formation?

Answer 7

urinary oxalate

Question 8

what are the two causes of increased oxalate?

Answer 8

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

Question 9

what helps prevent calcium phosphate and calcium oxalate crystallization?

Answer 9

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

Question 10

what are risks for calcium oxalate and calcium phosphate stones?

Answer 10

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

Question 11

what causes struvite stones?

Answer 11

MC women w/ recurrent URIs w/ urease producing bacteria

Question 12

what are struvite stones?

Answer 12

magnesium-ammonium-phosphate stone

Question 13

what are urease-producing bacteria?

Answer 13

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

Question 14

what is the acidity for calcium oxalate stones?

Answer 14

> 7.2

Question 15

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

Answer 15

increased urine alkalinity

Question 16

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

Answer 16

staghorn calculi

Question 17

what is the only amino acid insoluble in urine?

Answer 17

cystine

Question 18

what pH do cystine and uric acid stones form in?

Answer 18

pH <5.5

Question 19

what stones are radioopaque?

Answer 19

struvite

calcium

Question 20

what stones are radiolucent?

Answer 20

cystine

uric acid stones

Question 21

what increases the risk of uric acid stones?

Answer 21

think people that have malignancy or are undergoing malignancy treatment

myeloproliferative disorders

Question 22

clinical findings of stones?

Answer 22

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

Question 23

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

Answer 23

marked urinary urgency and frequency

Question 24

what pH will you see calcium phophate stones?

Answer 24

> 7.5

Question 25

what is the gold standard imaging for stones?

Answer 25

non contrast CT

Question 26

What imaging for stones if the patient is pregnant?

Answer 26

Renal US

Question 27

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

Answer 27

Non-contrast CT

Question 28

Asymptomatic stone treatment w/ no signs of infection?

Answer 28

Nothing

Question 29

What size stones will pass spontaneously?

Answer 29

<= 5-6 mm

Question 30

What is acute treatment for stones?

Answer 30

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

Question 31

What patients would you refer for stones?

Answer 31

``` 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 ```

Question 32

Who gets emergent urologic evaulation and drainage?

Answer 32

Obstructive urinary calculi w/ fever and infected urine

Question 33

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

Answer 33

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

Question 34

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

Answer 34

Ureteral stent

Question 35

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

Answer 35

Ureteroscopic stone extraction

Question 36

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

Answer 36

Percutaneous nephrolithotomy

Question 37

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?

Answer 37

Open stone surgery

Question 38

When is imaging maybe unnecessary for stones?

Answer 38

Recurrent

Question 39

What is the bottom line treatment for acute stone treatment?

Answer 39

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

Question 40

What are the labs for recurrent stones?

Answer 40

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

Question 41

What are prevention measures for stones?

Answer 41

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

Question 42

Treatment for recurrent stones?

Answer 42

``` 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

Question 43

How much should a patient urinate daily?

Answer 43

1.5-2 L/day

Question 44

What is the f/u for stones?

Answer 44

Chronic: Repeat 24 hr urine in 6 months Repeat stone analysis if interventions are failing Consider yearly CT to assess for new formation