Stone formation/ urolithiasis

Question 1

Name 6 different ethiologies for stone formation:

Answer 1

Deranged calcium metabolism
Cystine uria
Uric acid stones (urinsyra)
Infection stones
Genetic 
Drugs

Question 2

Name 5 ways calcium metabolism can be deranged:

Answer 2

Hypercalciuria
Hyperoxaluria
Hypocitraturia

Hyperuricosuria
Hypermagnesuria

Question 3

How will Hypocitraturia cause stones?

Answer 3

Low citrate: Powerful inhibitor of cristallization

Low pH: consumes citrate

Extra:
Thiazid induced Hypocitraturia:
Thiazid –>intracellular acidosis –>acidosis inhibits citrate synthesis –> increased cellular absorbtion of citrate –> low citrate in the urine

Question 4

What drug can cause Hypocitraturia and by what mechanism?

Answer 4

Thiazid induced Hypocitraturia:
Thiazid –>intracellular acidosis –>acidosis inhibits citrate synthesis –> increased cellular absorbtion of citrate –> low citrate in the urine

Question 5

What type of stones will hypocitraturia cause?

Answer 5

calcium oxalate

calcium phosphate

Question 6

What dietary supplement is full of citrate?

Answer 6

Orange juice

Question 7

What are the causes of Calcium oxalate stones?

Answer 7

Hypercalciuria
Hyperoxaluria
Hypocitraturia

Hyperuricosuria
Hypermagnesuria

Question 8

What are the causes of Calcium phosphate stones?

Answer 8

Hypercalciuria

Hypocitraturia

Question 9

Hyperuricosuria,

what is the cause?

Answer 9

high uric acid in the blood

excess of purine intake:
most often cause by gout
but also by systemic disease such as
type 2, metabolic syndrome proliferative syndrome, drugs etc.

or/and

low pH
caused by for example
insulineresistance, metabolic syndrome, diarreah

Question 10

Treatment for hyperuricosuria?

Answer 10

Allopurinol

Question 11

Treatment for hypocitraturia:

Answer 11

Correct hypokalemia and pH
give
potassium chloride or
potassium citrat (kaliumcitrat)

Question 12

Causes of hyperoxaluria:

Answer 12

Low diuresis
High oxalate intake
Low calciumintake

Question 13

Treatment for hyperoxaluria:

Answer 13

Increase fluids
Limit oxalate (chocolate, spinach, nuts etc)
Limit fat
Increase calcium
Vitamin B6
Correction of bowel pathology

Question 14

Thiazides effect on stone formation:

Answer 14

Thiazid induced Hypocitraturia:
Thiazid –>intracellular acidosis –>acidosis inhibits citrate synthesis –> increased cellular absorbtion of citrate –> low citrate in the urine

Thiazides can increase calciumreabsorbtion and be used for the treatment of hypercalciuria

Question 15

Causes of hypercalciuria:

Answer 15

Low diuresis
High calcium intake
High protein intake
High salt intake

Metabolism: hyperparathyreoidism

Question 16

Treatment for hypercalciuria:

Answer 16

Increase fluids
Limit calcium
Limit protein
Limit fat

Thiazides:
increases calciumreabsorbtion

Question 17

What is the effect of animal protein on stone formation?

Answer 17

more uric acid due to purine load

low urine pH due to acid load (hypocitraturia)

high calcium due to low pH

Question 18

What are the causes of Cystine uria?

Answer 18

Low diuresis
High protein intake
High salt intake
High intake of methionine food (Parmesan, egg, horsemeat etc.)
Low pH

Question 19

Treatment of Cystine uria:

Answer 19

Increase fluids
Limit protein
Limit fat
Limit salt
Limit methionine

Tiopronine
Potassium citrate (kalium citrat)

Question 20

Name 4 infection stones:

Answer 20

Hydroxy apatite
Carbonate apatite
Struvite (Magnesium ammonium phosphate)
Ammonium urate

Question 21

Treatment of infection stones:

Answer 21

Remove stone and treat UTI

Question 22

Vilka stenar passar för ESWL-behandling?

Answer 22

sten ≤ 2 cm
i njurbäckenet
i övre och mellan kalkar

går även för uretärstenar men är mindre effektivt

Question 23

När kan man genomföra “akut” ESWL?

Answer 23

singelsten i PUJ < 1,5 cm
avflödeshinder
inom 24-48 H
inget ödem eller "impacted" sten
dilatation pga obstruktionen

Question 24

Hur vanligt är det med njurstensanfall efter ESWL?

Answer 24

2-4%

Question 25

ESWL-komplikationer:

Answer 25

infektion
hematuri
hematom
kvarvarande sten/steinstrasse

Question 26

Finns ngn roll för läkemedel i samband med ESWL?s

Answer 26

calcium-blockerare (nifedipin)- uretär relaxation

a1-blockerare (alfusozin) - uretär relaxation

Minskar tiden för stenavgång
Ger mindre smärta
Ökar andelen stenfria

Question 27

Vilka stenar anses vara hårda?

Answer 27

> 1000 HU

calcium oxalate monohydrate
cystine
brushite

Question 28

Indikationer för öppen kirurgi av stenar:

Answer 28

anatomiska avvikelser

• hästskonjure
• malroterad njure
• PUJ-stenos m stenar
• ektopiska njurar

stenar i divertiklar

andra behandlingsmetoder har misslyckats eller är inte tillgängliga

Question 29

Vad består struvite av?

Answer 29

Infektionssten bestående av

Ammonium photsphate

Question 30

Vad står RTA för och vilken typ kommer med stenbildning?

Answer 30

Renal Tubular acidosis

Typ 1

Question 31

Vilka stenar syns inte med DT?

Answer 31

Indinavir

Question 32

Hur skall stenanalys utföras?

Answer 32

Infrared spectoscopy IRS
alt
x-ray diffraction XRD

Question 33

Vilken typ av sten orsakar proteus?

Answer 33

Magnesium ammonium phosphate

Question 34

Vad kan orsaka cystinuria?

Answer 34

Ärftligt tillstånd (autosomalt recessivt)
vanl hos kvinnor
minskad cystinabsorbtion från tubuli och tarm –> ökat PH

Question 35

Hur vanligt är det med Steinstrasse efter ESWL?

Answer 35

4-7%