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Renal > Stones > Flashcards

Stones Flashcards

0
Q

nephrolithiasis

A

stone in upper UT or collecting system

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1
Q

calculus

A

concretion anywhere in the system

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2
Q

bladder stones

A

stones in bladder

MC in underdeveloped countries

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3
Q

nephrocalcinosis

A

calcification with renal parenchyma

rare, rarely cortex, uncommon

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4
Q

5 major types of stones

A 
calcium oxalate 
calcium phosphate 
uric acid
cystine
struvite
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5
Q

calcium oxalate monohydrate

A

whewellitte

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6
Q

calcium oxlate dihydrate

A

weddellite

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7
Q

struvite

A

urease stones
infection stones
triple phosphate stones
magnesium ammonium phosphate

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8
Q

supersaturation

A

ratio of salt/solubility
ss1 crystals
*can be changed by increase or decrease in urine volume

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9
Q

stones result from

A

phase change (dissolve salt–>ppt)

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10
Q

free particle model

A

crystal nuclei occur because increase in super saturation in dissolved salts present in ultrafiltrate (colelcting duct)

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11
Q

fixed particle model

A

crystal nuclei form in lumen of nephron and adhere to tubular epithelial (requires renal cell injury)

jux of CD and papilla

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12
Q

randall’s plaque hypothesis

A

loss of normal urothelial covering of renal papilla exposes a randall’s plaque (nidus of interstital CaPo4) that urine crystals can attach and grow on

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13
Q

CaOx stone disease and antibitoics

A

oxalobacter formigenes uses oxalate to make ATP

if these bacteria decrease by antibiotics, oxalate will increase, risk of stones increases

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14
Q

oxalates

A 
coffee
tea
nuts
rhubarb
strawberries
cranberry juice
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15
Q

metabolic defects taht could lead to CaOx stones

A

hypercalciuria
hyperoxaluria
hyperuricosuria
inhibitor deficiency

16
Q

how do you get hyperoxaluria?

A

increase in production (congenital, too much vit C, glycol)

OR decrease Ca to bind due to malabsorption–>too much oxalate absorbed through intestine

17
Q

treatmetn of hyperoxaluria

A

ca or mg supplemetation + treating malabsorption

18
Q

uric acid crystals and hyperuricosuria

A

uric acid cyrystals may form nucleus for caox salt ppt–> treat with thiazide and allopurinol

19
Q

how do you get excess uric acid?

A

increase in purne–>increase uric acid–>bone buffering along with excess Ca–>crystals

increase purine from meat, gout, post chemo, lesch-nyans

20
Q

different inhibitor deficiencys

A

cirtate- complexes with Ca to dissolve (lost in chronic acidosis-RTA 1, CRG, acetazolamide)
Mg- forms sol complex with Ox
oral orthiphosphate-decreases Ca excretion
inorganic pyrophosphate

21
Q

CaPO4 stone risk factors

A

hypercalciuria

alkaline urine

22
Q

uric acid calculi are the

A

only truly radiolucent stones

23
Q

tx uric acid cyrstals

A

k+ cirtate (urine alklakinization)

24
Q

cystne stones

A

cystinuria due to an AR disease involving defect in 5 dibasic amino acids (COLA) transport in nephron and gastric mucosa, but only increase cysteine causes clinical manifestations

25
Q

Clinical cysteine stones

A

children
mildly radio-opague staghorn nuclei-hexagonal crystals
renal parenchymal dmaage

26
Q

tx cysteine stones

A

d-penicilamine-disrupts disulfide bonds in cystine

27
Q

struvite stones are main cause of

A

staghorn stones

28
Q

struvite stones are the MCC of

A

stones in women and paraplegics

29
Q

struvite stones form from

A

supersaturation with Mg-ammonium PO4

30
Q

patho of struvite stone

A

form in presence of UTI with a urea-splitting organism
proteus, kleb, serratia, enterobacter
bacteria resides in stone and cause srecurrent UTI

31
Q

marker of struvite stones

A

alkaline urine (7.5-8)

32
Q

dx of struvite stones

A

stone analysis, cystine crystalluria (hexagons), cyanide nitroprusside test (qualitative), 24hr urine studies (quant)

33
Q

clinical for struvite stones

A

staghorn nuclei
recurrent uti
progressive renal insuffiency, urospesis, peripnephric abscess, obstruction

34
Q

intervene for stone with

A

uncontrollable pain
fever
1 kidney

35
Q

treatment for idiopathic hypercalcuria

A

hydrate, thiazides, diet that restricts Na, Ca, animal protein

36
Q

treatment of hyperuicosuria

A

allopurinol

37
Q

struvite treatment

A

antibiotics and urease inhibitors

38
Q

cystine treatment

A

hydrate, alkalinize, restrict Na, use d-pen to block sulfide bonds

Renal (17 decks)

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