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ESA3 > Urinary 7 - Urinary Stones > Flashcards

Urinary 7 - Urinary Stones Flashcards

1
Q

In what form is Calcium and Phosphate stored in bone?

A

Hydroxyapatite crystals [Ca10(PO4)6(OH)2]

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2
Q

How many grams of Calcium is stored within an adult skeleton and teeth?

A

~1000g

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3
Q

Which 2 hormones control serum calcium levels?

A

1) Parathyroid hormone

2) Calcitriol

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4
Q

What stimulus causes increased secretion of PTH?

A

Fall in serum Calcium levels

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5
Q

What tissues does PTH affect?

A

Kidneys

Bones

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6
Q

What affect does PTH have on the kidneys?

A
  • Increases Calcium resorption
  • Decreases Calcium excretion
  • Increases conversion of Calcidiol to Calcitriol via 1alpha-hydroxylase
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7
Q

What affect does PTH have on bones?

A
  • Increases osteoclast activity = increased bone resorption

- Decreases osteoblast activity

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8
Q

How does Calcitriol increase serum Calcium levels?

A

Acts on bone: Increases Osteoclast activity

Acts on small intestine: Increases Calcium absorption

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9
Q

How does Calcitriol increase Calcium absorption from the small intestine?

A

Increases the expression of Calcium Binding Proteins on apical gut wall

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10
Q

What enzymes converts Calcidiol to Calcitriol?

A

1alpha-hydroxylase

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11
Q

What is the function of 1alpha-hydroxylase?

A

Converts Calcidiol to Calcitriol

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12
Q

Where does the majority of Calcium and Phosphate resorption take place?

A

Proximal Convoluted Tubule

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13
Q

What are the 4 types of Calcium stones?

A

1) CaOx + CaP
2) CaP only
3) Struvite (Magnesium Ammonium Phosphate Hexahydrate)
4) Uric acid

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14
Q

Name 3 types of stones which are not made up of Calcium:

A

1) Cysteine stones
2) Drug stones
3) Ammonium acid urate stones

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15
Q

Name 3 drugs which may cause urinary stones:

A

1) Indinavir (for HIV)
2) Triamterene (Diuretic)
3) Sulphadiazine (Antibiotic)

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16
Q

What are the most common causes of hypercalcaemia?

A
  • Primary hypersecretion of PTH

- Destruction of bone tissue due to Myeloma or diffuse metastases

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17
Q

What is the most common type of urinary stone?

A

CaOx + CaP

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18
Q

Give 5 symptoms of hypercalcaemia:

A

1) Painful bones
2) Abdominal groans
3) Renal stones
4) Psychic moans
5) Severe muscle weakness

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19
Q

Are urinary stones more common in men or women?

A

Men 2:1

Except struvite stones which are more common in women due to increased incidence of UTIs in women

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20
Q

Which urinary stone can grow very quickly?

A

Struvite stones

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21
Q

What causes a Struvite stone?

A

Bacterial UTI, with bacteria which have Urease

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22
Q

What type of stone is often caused by hyperparathyroidism, or renal tubular acidosis?

A

CaP only stones

23
Q

Name some causes of hypercalciuria:

A
  • Increased Calcium absorption from GIT
  • Increased Calcium resorption from bone (immobilisation/weightlessness)
  • Excessive dietary Calcium intake
  • Hypercalcaemia
24
Q

What type of diuretics can cause hypercalcaemia?

A

Thiazide diuretics

25
Q

Name some causes of hyperoxaluria:

A
  • Primary = rare autosomal recessive genetic disorder
  • Increased intestinal Oxalate absorption (secondary to Crohns post resection usually)
  • Increased Oxalate intake and decreased Calcium intake
26
Q

Name some foods high in Oxalate:

A

Tea
Rhubarb
Spinach
Nuts

27
Q

What are the 2 common causes of CaP-only urinary stones?

A

1) Hyperparathyroidism

2) Renal tubular acidosis

28
Q

What condition predisposes to cysteine stones?

A

Cysteinuria

Rare genetic disorder

29
Q

What is Milk-Alkali syndrome?

A

Excessive intake of Calcium and absorbable alkali, resulting in hypercalcaemia, metastatic calcification and renal failure. Most commonly caused by post-menopausal women ODing on Calcium supplements

30
Q

Who is particularly at risk of developing uric acid stones?

A
  • Gout sufferers
  • People with an increased cell turnover (Lympho-/Myelo-proliferative disorders, or chemotherapy patients)
  • Dehydrated people
31
Q

What is the most common bacteria which causes Struvite stones?

A

Proteus mirabilis

32
Q

What shape do Struvite stones usually take, and where do they develop?

A

Staghorn shape

Renal pelvis and several calyces

33
Q

Who are predisposed to UTI’s?

A
  • Women (shorter urethra)
  • Spinal cord injury
  • Neurogenic bladder
  • Vesicoureteric reflux
  • Obstructive uropathy (enlarged prostate/pregnancy/stones/tumours)
34
Q

Describe renal colic:

A

Excruciating pain from flank radiating to iliac fossa or inner thigh (L1 distribution)
Bouts ~ 20-60 min
Untreated usually subsides within ~ hrs
Often with nausea/vomiting/pallor/sweating/restlessness/haematuria

35
Q

What causes renal colic?

A

Ureteric stone

Peristaltic contractions or spasm of ureter trying to expel stone

36
Q

What is the name of the pain associated with a ureteric stone?

A

Renal colic

37
Q

What type of pain is associated with a kidney stone?

A

Dull loin ache

38
Q

What is the maximum diameter of a urinary stone which can be passed?

A

< 5 mm

39
Q

At what diameter do urinary stones usually require intervention?

A

> 7 mm

40
Q

List some presentations associated with a urinary stone:

A
  • Man (or woman with recurrent UTIs)
  • Renal colic or dull loin ache
  • Urinary retention
  • Haematuria
  • Renal failure (fluid retention, drowsiness, SOB, fatigue, nausea)
41
Q

Why are many sufferers of urinary stones resistant to increasing their water intake?

A

Causes increased pain

  • Most have urinary retention due to obstruction, so more fluid will increase the pain
  • May be painful to urinate due to inflammation from obstruction/UTI
42
Q

What does MSU stand for?

A

Mid-Stream Urine sample

43
Q

Why would you want an MSU from a patient with suspected urinary stone?

A

Microscopy for casts/RBCs/crystals

Culture bacteria

44
Q

What type of stones are radio-opaque?

A
  • CaOx + CaP
  • CaP-only
  • Struvite
45
Q

What type of stones are radio-lucent?

A
  • Uric acid stones

- Triamterene stones

46
Q

Name some investigations performed when urinary stones suspected:

A
  • MSU (culture/microscopy)
  • Plain abdo X-Ray
  • Ultrasound
  • CT scan of kidney, ureter and bladder
  • Blood: FBC, CRP, renal function, electrolytes, calcium, phosphate and urate, creatinine
  • Ureteroscopy
47
Q

List some complications of urinary stones:

A
  • Acute pyelonephritis +/- septicaemia (Gram +ve)
  • Pressure necrosis of renal parenchyma
  • Urinary obstruction –> hydronephrosis
  • Ulceration through wall of collecting system
48
Q

What are the management options for someone with a urinary stone?

A
  • Analgesia (IV Diclofenac/Pethidine if in hospital, or NSAIDs if not)
  • Percutaneous nephrolithotomy
  • Extracorporeal Shock Wave Lithotripsy (ESWL)
49
Q

Describe ESWL (Extracorporeal Shock Wave Lithotripsy):

A

External focused high-intensity ultrasonic waves used to break up stones near renal pelvis
~ 30-60 mins

50
Q

What does ESWL stand for?

A

Extracorporeal Shock Wave Lithotripsy

51
Q

Which analgesia is usually given to patients admitted to hospital with a painful urinary stone?

A

IV Diclofenac/Pethidine

52
Q

Potassium citrate salts may promote the formation of which type of stones?

A

CaP-only

53
Q

How do Thiazide diuretics decrease the excretion of Ca2+?

A

Increase Ca2+ reabsorption

54
Q

Name some urinary stone preventions:

A
  • Increase water intake
  • Thiazide diuretics (decrease Ca2+ excretion)
  • Potassium citrate to alkalinise urine (can induce CaP stones)

ESA3 (48 decks)

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