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RU 1 > Urinary Stones > Flashcards

Urinary Stones Flashcards

1
Q

Most common stones

Ca
Others

A

Ca- Ca ox (MC)
Mixed Ca ox & Ca Phos
Pure Ca phos

Uric acid
Struvite (Mg/NH4/Phos)
Cystine

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2
Q

General stone RF

A

Too little water- conc urine, components crystallize
Inadequate intake/excess loss

Solid objects in urine
Catheters, sutures, FB, UA crystals, randall’s plaques

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3
Q

Randall’s plaques

A

Ca phos concretion in renal tubule
Plaque erods through urothelium
Stone (ca ox) deposits on plaque

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4
Q

RF for Ca Ox stone

Ca

Oxalate

Others

A

High urine level of stone components

Hypercalcemia
Hypercalciuria

Low level of inhibitors (citrate, Mg)
High urine levels of UA (ca ox stones for on UA)

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5
Q

Hypercalciuria only

Excess absorption of Ca from intestine
Renal leak of Ca

A

Blood Ca rises briefly (back to normal)
Kidneys excrete excess Ca
Idiopatic, inc VD activity

Blood Ca stays normal, inc absorption from gut/bone

Metab acidosis (bone demin)

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6
Q

Cause of high urine oxalate

A

Excess absorption from intestine
VC- oxalate in alkaline urine
Primary hyperoxaluria
AR do, defect in glyoxalate metab

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7
Q

Excesss oxalate absorption from intestine

A 
Idiopathic
Inc intake of high oxalate foods
Dec levels of O. formigenes
 in intestine which degrades oxalate
Dec bind of oxalate in gut (more free oxalate available)
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8
Q

High Oxalate foods

A 
Black tea
Dark beer
Cocoa
Nuts
Soy
Rhubarb/spinach
Black/blueberries. grapes
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9
Q

Oxalate binding in gut

Normal

Dec Ca in gut lumen

A

Oxalate binds Ca and Mg in colon
Bound eliminated in feces
Free oxalate absorbed in blood

Less oxalate bound
More free, absorbed in blood

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10
Q

Enteric hyperoxaluria

Dz

A

Celiac, CF, Chrons

Fat malabsorption, more fat to bind Ca
Less free Ca, oxalate unbound

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11
Q

Should Ca oxalate stone former dec Ca intake

Low Ca in gut

A

No

More free oxalate absorbed, inc stone formation

Low intake- osteo, does not decrease blood/urine levels

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12
Q

Ca oxalate vs Ca phosphate

Rf

Difference

A

High urine Ca a rf

Low pH= oxalate more likely
High pH= Ca phos more likely

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13
Q

Stone high in phos

Hyperparathyroidism

Distal RTA

A

Bone resorption- HCO3 and phos
Excess Ca, HCO3, phos in urine
Urine with high pH

Impaired excretion of acid by DN
high urine pH
High urine Ca

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14
Q

Uric Acid pathway

Humans

XO inhibitors

A

Adenosine/guanine- xanthine
Xanthine- UA (XO)

Humans have no uriacase- UA not soluble, can form crystals/stones

XO inhibitors dec UA production

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15
Q

UA stone RF

Medicines to treat gout

A

pH too low
UA pka is 5.35
low pH, inc free UA, precipitates

Too much UA in urine

Excess UA production

Inc UA excretion (uricosurics)

Dec serum, UA
inc stone risk by inc urine levels

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16
Q

Too much UA in urine

A 
Lots of red meat
Idiopathic
Myeloproliferative do
Chemo
HGRD
Glyocgen storage disease
17
Q

Struvite

Solubility and pH

May contain

A

Mg NH4 Phos

Low- soluble
High- not soluble

Ca phos

18
Q

Formation of struvite stones

Urease

Effect of ammonium

A

UTI with specific bacteria that have urease (urea splitters)

Hydrolyzes urea- ammonium

Inc urine pH, HPO4 dissociates and creates phos

when Mg present in urine, struvite

19
Q

MC urea splitters

A

Proteus mirabilis/others
Klebsiella
Psuedo
E coli

20
Q

RF for UTI

Infection stones grow ____ and fill ____

A

female
post menopausal
catheter
abnormal UT

fast
collecting system (staghorn stone)
21
Q

Cystine

A

2 cysteine joined by S-S bond

22
Q

Cystinuria

AR defect in intestine/tubule transport of

A

Do of AA transport

Cystine/ornithine/lysine/arginine

Dec tubular reabsorp of cystine- high urine cystine- stones

23
Q

Cystine dx

A

Urine cystine level
Cystine stones
Hexagona crystals

24
Q

Cystinuria treatment

Drugs with SH replace 1 cysteine

A

Drink water for 1x nocturia

Tiopronin
D-penicillamine

25
Q

Diet recommendations

A

Drink water, create 2L of urine
Drink lemonade/OJ
Eat less animal protein- inc intestinal Ca absorption/purine
Dec sodium intake- kidneys reabsorb more, so Ca is too

RU 1 (11 decks)

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