Urinary and thirst Flashcards
1
Q
Diabetes complications - acute: (3)
A
- Diabetes ketoacidosis: DKA (usually T1D)
- Hyperglycaemic hyperosmolar state: HHS (usually T2D)
- Hypoglycaemia
2
Q
DKA characteristics (usually T1D)
- Glucose
- osmolality
- Ketones
- pH
- Hydration
A
- glucose > 11mmol/L
- Variable osmolality
- Ketonaemia >3mmol/L
- Acidosis pH < 7.3
- Less severe hypovolaemia
3
Q
HHS characteristics (usually T2D):
- Glucose
- osmolality
- Ketones
- pH
- Hydration
A
- Marked hyperglycaemia (>30mmol/L)
- Marked serum hyper osmolality (320>Osm/kg)
- <3 mmol/L
- no ketone driven acidosis
- Hypovolaemia (severe dehydration)
4
Q
Diabetes complications - chronic: microvascular (3)
A
- Retinopathy
- Nephropathy
- Neuropathy
5
Q
Diabetes complications - Macrovascular: (3)
- C A
- C
- P
A
- Coronary artery disease
- Cerebrovascular disease
- Peripheral vascular disease
6
Q
Poloyol pathway: (damage)
- Produces reactive….
- which cause damage to ….
A
- Produces reactive oxygen species which cause damage to blood vessels and endothelium, may cause neuropathy
7
Q
Protein kinase C pathway:
A
- Causes a variety of issues
- Activation increases VEGF causing new vessel formation in the back of the eye. These new vessels are ineffective, causing retinopathy and retinal bleeds
8
Q
Mechanisms of action for oral agents of DM
- Metformin
- Sulfonylurea
A
- Metformin: suppression of hepatic glucose
- Sulfonylurea: Increase in insulin secretion from beta cells
9
Q
Mechanisms of action for oral agents of DM:
- GLP-1 Agonist
- DDP-4 inhibitors
They’re linked
A
- DPP-4 inhibitors – inhibit GLP-1 degradation,
- GLP-1 agonist – promotes glucose dependent insulin secretion
10
Q
Sites of haematuria:
1. Glomerular
2. Non-glomerular (4)
A
- Glomerular
- Glomerulus - Non-glomerulus
- Kidney
- Ureter
- Bladder
- Urethra
11
Q
Flexible cytoscopy:
A
- A flexible cystoscopy is a test that allows the doctor to look directly at the lining of the bladder, from the opening of the urethra. During the procedure a thin flexible ‘fibre-optic’ tube called a cystoscope is passed through the urethra
12
Q
CT urogram:
A
- used to examine the kidneys, ureters and bladder
13
Q
Sensitivity of visible haematuria for detecting cancer:
A
- Positive predictive value of haematuria for detecting cancer, especially in men
14
Q
Risk factors for kidney or urinary tract cancer: (4)
A
- Age
- Smoking
- Exposures to benzene, aromatic amines (dyes, road fumes), carcinogens, chemotherapy, high doses of analgesics
- History of: Irritative voiding symptoms, Chronic urinary infections indwelling urinary catheter, pelvic irradiation
15
Q
Glomerular causes of haematuria: (3)
- Antibody caused
- AN…
- Thin ….
A
- IgA nephropathy (+/- HSP)
- ANCA vasculitis
- Thin nephropathy
16
Q
Non-glomerular causes of haematuria: kidney (3)
A
- Cancer
- Stones
- Trauma
17
Q
Non-glomerular causes of haematuria: Ureters (2)
A
- Cancer
- Stones
18
Q
Non-glomerular causes of haematuria: bladder (4)
A
- Cancer
- Infection
- Non-infective cystitis
- Stones
19
Q
Non-glomerular causes of haematuria: Urethra (3)
A
- Cancer (prostate)
- Infection (prostatitis)
- Trauma
20
Q
Clinical approach to haematuria:
- Confirm
- Check
- When
- Check
A
- Confirm haematuria by using a dip stick
- Check history for specific cause
- When appropriate, screening of whole urinary tract for cancers
- Check glomerular causes, rarer but still a possibility
21
Q
Raised hydrostatic capillary pressure origin example : rise in venous pressure (3)
A
- Left heart failure: pressures rise in the dependent (pulmonary) circulation
- Insert pulmonary catheter to find pulmonary capillary pressure
- If PCP rises above 25mmHg then frank pulmonary oedema occurs
22
Q
Systemic oedema:
- How
- Where
A
- Results from raised pressures in the systemic venous circulation leading to fluid accumulation in the interstitial spaces
- Often affects the lower body; legs, feet and ankles
23
Q
Pitting oedema:
- Causes (2)
A
- A result of either a systemic problem, (heart, kidneys, liver function)
- Or localised problems with veins in the affected area (pregnancy and deep vein thrombosis)
24
Q
Increased extravascular colloid osmotic pressure due to an increase in π i
- What causes it
- How
- When
A
- Capillary leak syndrome
- The release of cytokines causes proteins to accumulate in the extravascular space
- Occurs in sepsis and burns
25
Interstitial fluid: transudate
- Filtrate of.....
- Protein content
- Caused by (2)
- A plasma filtrate
- low protein content (<30 g/l
- increase capillary hydrostatic pressure i.e. cardiac/nephrotic/renal failure
- Reduce colloid osmotic pressure i.e. malnutrition
26
Interstitial fluid: exudate
- Filtrate of.....
- Protein content
- Caused by, example
- plasma
- High protein content: >30 g/l
- Factors that increase extravascular colloid osmotic pressure, i.e. increased capillary permeability to protein (burns, sepsis)
27
Capillary hydrostatic pressures (P):
- Generated by ....
- What does it cause?
- Propulsive forces
- When Pc > Pi , net filtration
28
Colloidal osmotic pressures (π):
- Generated by ....
- What does it cause
- Impermeable protein concentrations
- when πc > πi , Net absorption
29
Reduced plasma colloid osmotic pressure (πc): Nephrotic syndrome - explanation
- Presentation
- Nephrotic syndrome: damage to basement membrane of the glomerulus results in proteinuria and hypoalbuminaemia
- Oedema around the eyes, puffy face, pitting oedema of feet and ankles
30
Reduced plasma colloid osmotic pressure (πc): impaired protein synthesis
- Causes (3)
M
M S
I H S
- Malnutrition: reduced protein intake causes oedema around the belly (Kwashiorkor)
- Malabsorption syndromes: Pancreatic insufficiency, Cystic fibrosis, Intestine surface damage
- Impaired hepatic synthesis
31
Common causes of transudate effusion (increase in Pc or decreased π): (5)
- C/H/R
- N S
- P D
- P
- P E
- Cardiac/hepatic/renal failure
- Nephrotic syndrome
- Peritoneal dialysis
- Pericarditis
- Pulmonary embolism
32
Common causes of exudate effusions:
- P/TB
- I C
- C
- P
- P E
- Pneumonia/TB
- Inflammatory conditions
- Cancer
- Pancreatitis
- Pulmonary embolism
33
Non-cardiogenic pulmonary oedema:
- What is it?
- What causes it?
- Pulmonary oedema with no increase in pulmonary wedge pressures >18 mmHg
- Results from increased permeability of pulmonary capillaries from a direct or indirect pathological insult
34
Acute Respiratory Distress Syndrome (ARDS): causes
- F O
- P
- I I / D
- Re-E
- N C
- H A E
- Fluid overload
- Pancreatitis
- Inhalation injury / drowning
- Re-expansion of lungs after draining
- Neurogenic causes - head trauma / haemorrhage
- High altitude exposure
35
Acute Respiratory Distress Syndrome (ARDS):
- Definiton (specific to...)
- Diagnosis requires (3)
- A non-cardiogenic pulmonary oedema and diffuse lung inflammation syndrome (SPECIFIC)
1. Acute onset (1 week)
2. Bilateral opacities on chest X-ray
3. PaO2/FiO2 ratio of <300 on PEEP
36
Ascites:
- What is it?
- What causes it?
- Fluid accumulation in the abdomen
- Portal hypertension, due to cirrhosis
37
Ascites: portal venous pressure increase causes (4):
- H D & F
- R P-H V P
- R H V D
- I V F
- Hepatic damage and fibrosis
- Raised post-hepatic venous pressures
- Reduced hepatic venous drainage
- Increased venous inflow
38
Non-pitting oedema caused by myxoedema:
- Association
- How does it cause oedema? (Mucop....)
- Myxoedema is commonly associated with severe hypothyroidism
- excessive deposition of mucopolysaccharides in the skin/dermis which attract water, leading to swelling
39
Lymph has three major functions:
- Protein
- Fat
- Immune
- Return protein and fluid from the extravascular fluid to maintain low protein conc.
- Aid absorption and transport of fat from the small intestine
- Immunological role - lymph glands, circulation of immune cells, removal of bacteria
40
Lymphoedema:
- Definition
- The lymphatic system fails to drain lymph, which accumulates in the tissues, usually arms and legs
41
Primary lymphoedema:
- A rare genetic condition whereby the lymphatic system fails to develop properly
42
Secondary lymphoedema:
- Many causes (6)
- s
- R
- C
- I/P I
- I C
- V D
- Basically anything that blocks/damages the lymph nodes
- Surgery
- Radiation treatment
- Cancer
- Infection/parasitic invasion
- Inflammatory conditions
- Venous diseases
43
Osmole:
- A unit of osmotic pressure equivalent to the amount of solute that dissociates in solution to form one mole of particles
44
OsmolaLity:
- Measure of the osmoles of solute per Kg of solvent
45
OsmolaRity:
- Measure of the osmoles of solute per L of solution
46
Polyuria:
Polydipsia:
Polyuria: excessive urine output
Polydipsia: excessive drinking
47
SIADH effects:
- Sodium/serum osmolality
- Urine output
- Urine osmolality
- Decrease
- Decrease
- Increase
48
Dehydration effects:
- Sodium/serum osmolality
- Urine output
- Urine osmolality
- Increase
- Decrease
- Increase
49
Diabetes insipidus:
- Sodium/serum osmolality
- Urine output
- Urine osmolality
- Increase
- Increase
- Decrease
50
ADH (anti-diuretic hormone): function
* ADH induces expression of water transport proteins in the late distal tubule and collecting duct to increase water reabsorption
51
ADH: method of action (3 steps)
- acts on …
- Increases water…
- by phosphorylation of….
* Acts on renal collecting ducts via V2 receptors to
* increase water permeability (cAMP-dependant mechanism)
*by phosphorylation of aquaporin, which leads to decreased urine formation
52
Causes of polydipsia: (6)
- D I
- D M
- P P
- Hc/E
- D
- U
* Diabetes insipidus
* Diabetes mellitus
* Primary Polydipsia
* Hypercalcaemia/Electrolyte disturbances
* Diuretics
* UTI
53
Diabetes insipidus: what is it?
- Disorder of AVP release or action
54
Diabetes insipidus - signs and symptoms: infants
- Forceful sucking
- Soaked nappies
55
Diabetes insipidus - signs and symptoms: Young children
- Primary enuresis
- Toilet training differences
56
Diabetes insipidus - signs and symptoms: older children
- High urinary output
- Nocturia
- Tiredness
57
Water deprivation test: Diabetes insipidus is confirmed if: (3)
- Plasma osmolality is rising
- Plasma Na is elevated
- Urine osmolality remains dilute
58
What is the cause of DI?: central
- Caused by
- Check for ....
- Other testing (2)
- Isolated ?????
- AVP deficiency
- Check for other pituitary hormones - ACTH, TSH, LH, FSH, Prolactin
- GH testing may be required
- MRI brain
- Cranial or Central DI is rarely isolated
59
What is the cause of DI?: nephrogenic
- Caused by
- How to test for it
- AVP resistance
- Genetic testing for mutation in AVP receptor
60
How to clinical test for nephrogenic vs central DI?
- Administer test dose of DDAVP (desmopresin) at the end of deprivation test
- If urine becomes concentrated = Central DI
- If no change occurs = Nephrogenic DI
61
SIADH: Signs and Symptoms (2)
- Reduced urine output
- Reduced sodium (dilutional) = nausea, vomiting, cramps, irritability, rarely seizures
62
SIADH meaning:
- Syndrome of Inappropriate ADH Secretion
63
Causes of SIADH:
- T
- C D
- CN
- D
- R O
- Tumours
- Chest disease
- CNS disorders
- Drugs
- Reset osmostat
64
Diabetes Mellitus: symptoms
- P
- P
- W
- F
- A
- N
· Polydipsia
· Polyuria
· Weight loss
· Fatigue
· Abdominal pain
- Nocturnal enuresis
65
How does diabetes cause these symptoms?
- Polyuria and Polydipsia
1. Increase in glucose
2. Renal excretion of glucose
3. Osmotic diuresis with excessive water loss (polyuria)
4. Dehydration
5. Polydipsia to compensate
66
Diabetic Ketoacidosis (DKA): How does an insulin deficiency cause acidosis
1. Increased lipolysis
2. Increased FFA to the liver
3. Ketogenesis
4. Acidosis
67
DKA: treatment
· Mainstay of treatment:
- Rehydrate with IV fluids gradually over 48 hours
- Treat insulin deficiency with IV insulin
- Close monitoring of clinical condition, electrolyte and glucose levels
68
Diabetes mellitus: treatment
- Insulin
· Chronic disease management
· Screening for complications of diabetes
69
Primary Polydipsia:
· Excessive fluid intake caused by a behavioural
component
· Often from drinking non-water substances
· Don't restrict water until DI or DM excluded
70
Psychogenic polydipsia:
- Psychogenic polydipsia: used to describe the association between polydipsia and psychiatric disorders e.g. schizophrenia/anxiety disorders (6-20% prevalence)
71
Diuretics: what do they do? (2)
- They reduce Na+ reabsorption in the tubular nephron, increasing Na+ excretion.
- An increase in Na+ in the urine increases water excretion by osmosis
72
Diuretics: why are they used? (2)
- Removal of .....
- Combinations of .....
- For the removal of fluid accumulations from interstitial space or the circulation when these have clinical consequences
- Combos of diuretics can be used to offset potential side effects
73
Osmotic diuresis: two possible principles of action
1. Osmotic diuresis
2. Ion transport modulators
1. Add an impermeable solute to tubular fluid, to reduce H2O reabsorption
2. Reduce Na+ reabsorption across the tubular membrane
74
Osmotic diuresis - Mannitol
- Method of action
- Filtered at glomerulus and is poorly reabsorbed, raises plasma and tubule osmolarity, reducing loss of Na+ in diuresis
75
Mannitol - Clinically useful characteristics (2)
- Does not enter eye or brain. This makes it useful in the treatment of raised intracranial/intraocular pressure
- Useful to drain relatively inaccessible oedema accumulations
76
Proximal tubule mechanics:
- Transport
- Flux
- Na+ in the tubule fluid is exchanged for H+, pumping Na+ into the epithelial cell where it is pumped out via an ATP-consuming Na-pump
- Na+ transport is accompanied by an osmotic flux (H2O) from tubular fluid
77
Carbonic Anhydrase (CA): role in proximal tubule
- Role
- How it does this in simple terms
- Inhibition
- CA catalyses the production of H2O and CO2 from HCO3- and H+
- It takes the H+ being exchanged for water and makes new water
- CA inhibition would reduce Na+ reabsorption and hence water re-uptake
78
Carbonic anhydrase inhibitors: Acetazolamide
- Action
- Effects
- Reduces Na+ reabsorption hence H2O reabsorption by suppressing H+ uptake
- Increases excretion of HCO3- (Na+, K+, H2O), causing metabolic acidosis and mildly alkaline urine
79
What does Acetazolamide treat?:
G
MA
P for AS
- Glaucoma: reduces the formation of aqueous humour
- Adjunct therapy in metabolic alkalosis
- Prophylaxis for altitude sickness
80
Mechanics of the ascending loop of Henle:
The concentration of … is generated by (2)
- The concentration gradient of the medullary interstitium is generated by:
1. An apical Na+/K+/2Cl- co-transporter
2. A basolateral Na-pump
- The ascending limb is impermeable to water
81
Loop diuretics: Furosemide
- Action (ascending)
- Aims of action (2)
- End result
- Inhibits the Na+/K+/2Cl- co transporter to:
1. Reduce the medullary interstitial conc. gradient
2. Maintain a greater tubule osmolality
- 20% of water load is usually reabsorbed by action of the co-transporter. Inhibition causes an equivalent water retention, causing a huge urine production increase
82
Loop diuretics: side effects (2)
- Hypovolaemia can occur leading to hypotension (lowered systemic arterial pressure)
- Loss of tubular fluid can result in hypokalaemia causing muscle weakness and possible ECG changes
83
Loop diuretic side effects: how to avoid hypokalaemia?
- Loss of excess K+ can be ameliorated by using loop diuretics in combination with K+-sparing diuretics
84
K+ sparing diuretics: Spironolactone
- Action
- Clinical use
- Blocks the aldosterone receptor, preventing the loss of K+ into the tubular fluid in the distal tubule
- This prevents hypokalaemia that can be caused by more powerful loop diuretics
85
K+ sparing diuretics: Amiloride and Triamterene
- Both block epithelial Na+ channels (ENaC), preventing loss K+ from Na+/K+ trade
- Limited efficacy in generating diuresis, so used in conjuction with stronger loop diuretics as a K+ preserver
86
K+-sparing diuretics: side effects
- Can cause Hyperkalaemia in patients with raised K+ from renal failure or diabetes
87
Renal tubule handling of ions and water:
- Transporter present
- What blocks this?
- Distal tubule cells express a Na+ - Cl- co-transporter that reabsorbs Na+ from the tubular lumen
- Thiazides
88
Thiazide-like diueretics:
- What are they?
- Action
- Example
- Several compounds that share the same effect but vary in structure.
- Block the Na+-Cl- co-transporter in the distal tubule , preventing reabsorption of Na+ from the tubular lumen
- Hydrochlorothiazide is a widely used example
89
Thiazide-like diuretics: side effects
- Hypokalaemia: Same as loop diuretics, thiazide-like diuretics increase urinary K+ losses
- Hypotension, dizziness and syncope due to hypovolaemia
90
Chronic kidney disease definition:
- Abnormal kidney function for more than 3 months, with implications for health
91
Three common causes of CKD:
- Diabetes
- Hypertension
- Obesity
92
eGfR meaning:
- Measures how much blood your glomeruli filters clean every minute based on your body size
93
Clinical utility of eGFR:
- Used to watch for the onset of kidney disease and monitor severity of existing cases
- >90 is normal
94
Non-specific advanced CKD symptoms: (5)
- Fatigue
- Loss of appetite
- Nausea/vomiting
- Itchy skin
- Cramp
95
CKD symptom presentation:
- usually minimally symptomatic
96
Acute Kidney Disease (AKD):
- Abnormal kidney function present for less than 3 months, with implications for health
97
Acute Kidney Injury (AKI):
- Abnormal kidney function present for less than one week, with implications for health
98
acute renal failure: prerenal
- Definition
- Causes (3)
- Sudden and severe drop in blood pressure or interruption of blood flow to the kidneys
- Diarrhoea, Bleeding, Burns
99
acute renal failure: Intrarenal
- definition
- Causes (3)
- Direct damage to the kidneys
- Acute tubular necrosis, Drugs, autoimmune
100
acute renal failure: Postrenal
- Defintion
- Causes
- Sudden obstruction of urine flow
- enlarged prostate, kidney stones, bladder tumour or injury
101
Causes of acute renal failure: prevalence
1. Prerenal
2. Intrarenal
3. Postrenal
1. 70%
2. 10%
3. 30%
102
Why can eGFRs not be used for AKD
- It takes a very large change in GFR to result in even a small measurable change in serum creatine (higher regions)
103
Symptoms of advanced AKD:
- Fatigue
- Loss of appetite
- Nausea/vomiting
- Cramp
104
End-Stage Kidney Disease (ESKD): Clinical definition (2)
- GFR < 15ml/min per 1.73m^2
OR
- If they are on dialysis/transplant
105
The different names of Kidney failure:
- AK13 if dialysed for AKI
- CKD5D if dialysed for CKD
106
Kidney functions: (6)
- Remove (1)
- Regulate (4)
- Control (1)
-Remove soluble waste products from the blood
-Regulate amount of water in the blood
- Regulate amount of sodium in the blood
- Regulate acidity in blood
- Control calcium and phosphate metabolism
- Regulate blood cell production (produces erythropoietin)
107
Treatment for kidney failure effectiveness: Dialysis
- Only restores removal of waste solutes and Salt/water balance
108
Treatment for kidney failure effectiveness: kidney transplantation
- Restores all kidney functions
109
Typical features of a patient with a surgical atriovenous fistula: (3)
- Purplish bulging veins
- Swelling in arms/legs
- Decreased BP/HF
110
Lower UTI: Distinguishing signs
- Nocturia
- Suprapubic pain
- NO FEVER
111
Lower UTI: definiton
- Simple cystitis of the bladder/urethra
112
Upper UTI: definition
- Pyelonephritis (complicated infection) of the Aorta/Inferior VC/Ureters/Kidneys
113
upper UTI: distinguishing signs
- Fever
- Flank pain (renal angle tenderness)
- Raised heart rate
114
Micro-organisms that commonly cause UTI:
- E. coli (most common)
- Staphylococcus: colonises the UT and perineum
115
Common risk factors for urinary tract infections: Structural (4)
- Female
- Pregnancy
- Abnormal UT (congenital)
- Malignancy
116
Common risk factors for urinary tract infections: co-morbidities (5)
- Diabetes
- Immunocompromised
- Urinary catheter
- Ureteric stent
- Previous UT
117
Common risk factors for urinary tract infections: Other risk factors (2)
- Sexual activity
- Dehydration
118
Signs of UTI on dipstick: (3)
- Raised leukocyte levels
- Raised Nitrite levels
- RBC: Haematuria
119
Suspected UTI: when to use a dipstick test?
- Women (under 65) with suspected UTI
- Infants/children under 16 with suspected UTI
120
When to use Urine cultures: (5)
- Over 65 is symptomatic and antibiotic given
- Suspected polynephritis or sepsis
- Suspected UTI in men
- Urinary catheter in place
- Failed antibiotics/recurring UTI
121
Nervous control of the lower urinary tract -
bladder: M3 receptors
- Stimulated by
- Innervation type
- Effect
- Stimulated by ACh via the pelvic nerve
- Parasympathetic (pelvic) nerve
- Excitatory -> cause muscle contraction
122
Nervous control of the lower urinary tract -
bladder: B3 receptors
- Stimulated by .....
- Innervation type
- Effect
- Stimulated by NA via the hypogastric nerve
- Sympathetic nerve
- Inhibitory -> causes muscle relaxation
123
Nervous control of the lower urinary tract -
Urethra: a1 receptors
- Stimulated by...
- Innervation type
- Effect
- Stimulated by NA via the hypogastric nerve
-Sympathetic nerve
- Excitatory -> urethra contraction
124
Nervous control of the lower urinary tract -
External urethral sphincter: nicotinic receptors
- Stimulated by
- Innervation type
- Effect
- Stimulated by ACh via Pudenal nerve
- Somatic innervation
- Excitatory -> EUS opens
125
The micturition cycles: peripheral nervous system: filling
- General state
- Parasympathetic
- Sympathetic
- Pudenal
- Bladder is relaxed; outflow tract contracted
- Parasympathetic nerve (S2-S4) inactive
- Sympathetic nerve (T11-L2) active, maintains bladder relaxation
- Pudenal nerve (S2 to S4) active, retain EUS closure
126
The micturition cycles: peripheral nervous system: voiding
- General state
- Parasympathetic
- Sympathetic
- Pudenal
- Bladder contracts, outflow tract relaxed
- Parasympathetic nerve: active, releases ACh, bladder contracts and urethra relaxes
- Sympathetic nerve inactive
- Pudenal nerve less active, EUS opens
127
The micturition cycles: Sacral coordination (CNS):
- PMC
- PMC, upon stimulation, leads to detrusor muscle contraction and urethral sphincter relaxation -> urination
128
Measurement of urinary tract function: Frequency-volume chart
- When is it used?
- What does it look at?
- Used in initial assessment for LUT
- Looks at nocturia, leakage, frequency
129
Measurement of urinary tract function: Ultrasound-bladder scan
- What does it look at
- When is it used
- Looks at residual volume and problems (UTI, CKD), can measure bladder volume
- Specialist assessment, bladder should void completely
130
Measurement of urinary tract function: Volume-flow measurements
- Filling urodynamics and video-urodynamics
- If a patient fails to respond to a conservative treatment of drugs
131
Types of urinary tract stones: Calcium stones
- Formation
- Risk factors
- Formed from calcium oxalate / phosphate
- Risk factors: hypercalciuria, hyperoxaluria and hyperparathyroidism
132
Types of urinary tract stones: Uric acid stones
- Risk factors
- Risk factors: High purine intake or malignancies
133
Types of urinary tract stones: Cystine stones
- Risk factors
- Risk factors: Reduced renal tubular reabsorption of cysteine, ornithine, lysine and arginine
134
Types of urinary tract stones: Struvite stones
- Made of
- Risk factor (bacterial)
- Made of magnesium ammonium phosphate
- Risk factors: chronic UTI of gram-ve, urease positive organisms
