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From Flashcardlet > SU2M - Urinary Stones and Obstructions > Flashcards

SU2M - Urinary Stones and Obstructions Flashcards

0
Q

7 Risk factors of Kidney stones?

A
  1. Low fluid intake
  2. Family history
  3. COnditions that precipitate stone formation = gout, Chron’s disease, hyperparathyroidism, type 1 RTA
  4. Medications = loop diuretics, acetazolamide, antacids, chemo drugs that cause the break down of cells (increase uric acid)
  5. Male gender –> 3x more likely to have urolithiasis
  6. UTIs –> esp w/ urease-producing bacteria
  7. Dietary factors = low calcium and high oxalate intake
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1
Q

Nephrolithiasis

A

development of stones within the urinary tract

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2
Q

4 Most common types of stones? Percentages?

A
  1. Calcium stones = 80-85%
  2. Uric acid stones = 10%
  3. Struvite = 5-10%
  4. Cystine stones = 1%
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3
Q

What are calcium stones composed of?

A
  1. Calcium oxalate –> most common
  2. Calcium phosphate
  3. Both
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4
Q

Which types of kidney stones are radiodense? radioluscent?

A
  • Radiodense = calcium & struvite stones

- Radioluscent = uric acid stones & cystine

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5
Q

7 Causes of hypercalciuria? What can they lead to?

A
  1. ^^ intestinal absorption pf Ca
  2. vv renal absorption of Ca –> ^^ renal excretion of Ca
  3. ^^ bone reabsorption of Ca
  4. primary hyperparathyroidism
  5. sarcoidosis
  6. malignancy
  7. vitamin D excess
    * *can cause calcium kidney stones
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6
Q

3 Causes of hyperoxaluria? What can they cause?

A
  1. Severe steatorrhea of any cause –> absorption of oxalate –> calcium oxalate stone formation
  2. Small bowel disease or Chron’s disease
  3. Pyridoxine deficiency
    * *can cause calcium oxalate kidney stones
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7
Q

What are uric acid stones associated with?

A

-associated with hyperuricemia, secondary to gout or chemotx that causes an increased breakdown of cells (the dying cells release purines)

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8
Q

Dx of uric acid stones?

A
  • radioLUCENT

- need to use CT, ultrasound, or IVP

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9
Q

4 Urease-producing bacteria? What can they cause?

A
  1. Proteu
  2. Klebsiella
  3. Serratia
  4. Enterobacter spp.
    * *can cause struvite kidney stones
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10
Q

Pathogenesis of struvite stones?

A
  • facilitated by alkaline urine
  • the urea-splitting bacteria convert the urea into ammonia –> produce alkaline urine
  • the ammonia combines with magnesium and phosphate –> form struvite calculi
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11
Q

Cause of cystine stones?

A

-genetic predisposition = cystinuria = autosomal recessive

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12
Q

Kidney stone sizes and ability to pass spontaneously?

A
  • > 1 cm = usually do NOT pass spontaneously

- < 0.5 cm = usually pass spontaneously

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13
Q

Recurrence and kidney stones?

A

-up to 50% of patients with stone will have a recurrence within 10 yrs of having their first stone

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14
Q

5 Ssx of kidney stones?

A
  1. Renal colic
    - description of pain: sudden, severe, occurs in waves
    - location: begins in flank, radiates anteriorly to the groin (follows the path of the stone)
  2. Nausea
  3. Vomiting
  4. Hematuira (seen in 90%)
  5. UTI
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15
Q

4 Lab tests for the diagnosis of kidney stones?

A
  1. Urinalysis –> look for:
    - hematuria
    - UTI
    - crystals
    - determine urine pH
  2. Urine culture –> if an infection is suspected
  3. 24-hour urine
  4. Serum chemistry
16
Q

Alkaline urine and kidney stones?

A

-can indicate an infection with urease-producing bacteria & struvite stone

17
Q

Acidic urine and kidney stones?

A

-suggestive of uric acid stones

18
Q

What does hematuria + pyuria indicate?

A

-stone plus and infection

19
Q

Gold standard for dx of a kidney stone?

A
  • CT scan (spiral CT) without contrast

- ALL stones (even radioluscent) will be visible

20
Q

Intravenous pyelogram (IVP) and kidney stones?

A
  • most useful test to determine the degree and extent of urinary tract obstruction
  • not usually necessary for the dx of kidney stones, but can be used to determine if the pt needs procedural tx
21
Q

Renal ultrasound and kidney stones?

A
  • test of choice for pts who can’t receive radiation (ex. pregos)
  • can detect hydronephrosis or hydroureter
  • false-negatives are common in the early obstruction
22
Q

KUB radiograph?

A
  • Xray of the Kidneys, Ureter, & Bladder

- can be used to dx radioDENSE stones

23
Q

3 General Tx for all types of kidney stones?

A
  1. Analgesia = IV morphine or parenteral NSAIDs
  2. Vigorous fluid hydration
  3. Antibiotics –> if UTI is present
24
Q

4 Indictions for hospitalization with kidneys stones?

A
  1. Pain not controlled by oral meds
  2. Anuria = uaully seen in pts with only one kidney
  3. renal colic + UTI &/or fever
  4. large stone = > 1 cm
25
Q

Most common method of surgery for kidney stones? What is it? Describe? Used for what kind of stones?

A
  • extracorporeal shock wave lithotripsy
  • breaks the stone apart –> once broken down the stone can pass spontaneously
  • for stones > 5cm, but < 2 cm diameter
26
Q

Percutaneous nephrolithotomy: when is it used?

A

-used when lithotripsy fails, or when the stone is > 2cm in diameter

27
Q

3 Dietary measures for preventing kidney stones?

A
  1. High fluid intake
  2. Limit animal protein in pts with hyperuricosuria & uric acid stones
  3. Limit calcium intake, ONLY if the pt has calcium stones
28
Q

2 Pharmacologic measures for preventing recurrence of kidney stones?

A
  1. Thiazide diuretics = reduces urinary calcium in pts with hypercalciuria
  2. Allopurinol = for pts with high uric acid levels
29
Q

7 Causes of lower urinary tract obstructions?

A
  1. BPH
  2. Prostate cancer
  3. Urethral stricture
  4. Kidney stone
  5. Neurological bladder problems –> ex. MS or DM
  6. Trauma –> ex. pelvic fracture or saddle injury
  7. Bladder cancer
30
Q

5 Ssx of urinary tract obstruction?

A
  1. Renal colic/pain –> more common with acute obstructions, chronic may be asymptomatic
  2. Oliguria
  3. Recurrent UTIs
  4. Hematuria or proteinuria
  5. renal failure
31
Q

Best initial test for dx of urinary tract obstruction?

A
  • renal ultrasound

- sensitive and specific for hydronephrosis

32
Q

What diagnostic tests should be used if the pt has an acute urinary obstruction + UTI?

A
  1. Renal ultrasound
  2. Excretory urogram
    * *relieve obstruction ASAP!

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