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In Service > Stones > Flashcards

Stones Flashcards

1
Q

Why do infants on furosemide develop stones?

A

Hypercalciuria causing nephrocalcinosis

Tx. change to thiazide

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2
Q

When do you perform 24 hour urinary analysis?

A

Recurrent stone formers
if patient wants
all kids or high risk patients

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3
Q

What is the pathophysiology of Cystinuria:?

A

inadequate resorption of cystine, ornithine, lysine, arginine (COLA) in proximal tubule

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4
Q

How do you diagnose Cystinuric stones?

A

Sodium Nitroprusside

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5
Q

How do you treat Cystinuric stones?

A
  • 1) K citrate, high fluid intake (3-4L/day), low salt/protein,
  • 2) Thiola (alpha mercaptopropionyl) or D-penicillamine if (1) fails
  • 3) Captopril if unable to tolerate (2)
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6
Q

What genetic marker is associated with cystinuria?

A

SLC

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7
Q

What is the pathophysiology of Ammonium Acid stones:?

A

Protein deficiency -> Phosphate deficiency -> high urinary ammonium levels

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8
Q

How do you diagnose Ammonium acid stones?

A

phenolphthalein

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9
Q

What conditions are associated with Uric acid stones?

A

Diabetes (defective ammonium excretion)
Chemo/rads for leukemia/lymphoma (cell lysis)
Ileostomy (acidosis from bicarb loss)
Lesch Nyan/gout

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10
Q

What is the pH of Uric Acid stones

A

< 5.5

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11
Q

How do you treat Uric Acid stones?

A

potassium citrate

allopurinol (if hyperurecemia ex. leukemia, Lesch Nyan)

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12
Q

What is the difference between brushite and apatite shones?

A

Both calcium phosphate
brushite pH < 6.6
apatite pH > 6.6

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13
Q

What condition is associated with calcium phosphate brushite stones?

A

hyperparathyroidism

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14
Q

What type of stone is struvite?

A

calcium phosphate apatite

magnesium ammonium phosphate

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15
Q

What type of organisms are associated with struvite stones?

A

Urease splitting (proteus, klebsiella, pseudomonas, staphylococcus)

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16
Q

What are Randall’s plaques made of?

A

Calcium apatite

17
Q

What is the pathophysiology of Hyperoxaluria Type 1

A

disorder of glyoxalate metabolism (AGT deficiency)

18
Q

What is the treatment of Hyperoxaluria Type 1?

A

B6, K citrate

Liver/kidney transplant

19
Q

What are some causes of hyperoxaluria?

A

short gut syndrome

chronic antibiotics

20
Q

When do you treat calcium oxalate stones with allopurinol?

A

Isolated hyperuricosuria

21
Q

What type of stones are formed from RTA Type I

A

calcium phosphate

22
Q

What is the pathophysiology of RTA type I?

A

Impaired acidification of distal tubule

23
Q

What are the urine characteristics of RTA Type 1 stone formers?

A

urinary alkaline, hypercalciuria, Hypocitrauria (<50)

24
Q

What should be considered in stone formers with hypomagnesuria?

A

Underlying bowel disease

25
Q

What is the risk of stones in pregnancy?

A

Same as general population

26
Q

What drugs produce stones by precipitating?

A

EMIT (radiolucent - too LIGHT to be seen)

Ephedrine
Magnesium
Indinovir
Triamterine

27
Q

What drugs produce stones by changing urinary metabolites?

A

Carbonic anhydrase
Loop diuretics
Topiramate
Zonlasamide

28
Q

What stones are most common in cystic fibrosis patient?

A

calcium oxalate

29
Q

what stones are the most resistant to SWL?

A

Cystine and Brushite

30
Q

What type of stones are associated with X linked phosphatemia?

A

calcium phosphate

31
Q

What diseases are associated with nephrocalcinosis?

A

Li Fraumeni
RTA Type 1
medullary sponge kidney

32
Q

What type of stones are common in Lesch Nyan?

A

uric acid

33
Q

What is the pathophysiology of medullary sponge kidney?

A

calcification of dilated intrapapillary collecting tubules

34
Q

how is medullary sponge kidney treated?

A

thiazides

In Service (12 decks)

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