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Y3 - Renal > Urinary tract Calculi > Flashcards

Urinary tract Calculi Flashcards

1
Q

what is urolithiasis?

A

the formation of stones anywhere in the urinary tract

  • kidney (most)
  • ureter
  • bladder
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2
Q

what is renal colic?

A

an acute, severe loin pain caused when a urinary stone:

  • moves from the kidney
  • obstructs the flow or urine through the ureter
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3
Q

What is hydronephrosis?

A

swelling of the renal pelvis and calyces in the kidney due to obstruction of the urinary tract causing back pressure into the kidneys

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4
Q

What is idiopathic hydronephrosis?

A

narrowing of the pelviureteric junction

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5
Q

Give 4 causes of obstruction within the lumen of the ureter:

A

1) calculus (stone)
2) blood clot
3) sloughed papilla
4) tumour of the renal pelvis, ureter or bladder

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6
Q

What is the renal papilla?

A

the tip of the renal pyramid where the collecting ducts drip urine into the minor calyx

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7
Q

Give 3 causes of sloughed papilla:

A

1) diabetes
2) analgesia misuse
3) sickle cell disease

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8
Q

Give 2 causes of renal obstruction from within the wall:

A

1) pelviureteric neuromuscular dysfunction
2) ureteric strictures
+ lots of congenital wall abnormalities

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9
Q

Give 5 external causes of renal obstruction:

A

1) tumours
2) diverticulitis
3) aortic aneurysm
4) retroperitoneal fibrosis
5) benign prostatic hypertrophy

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10
Q

Give 7 clinical features of urinary tract obstruction:

A

1) loin pain (often worsened by increased fluid intake)
2) anuria
3) terminal dribbling
4) sense of incomplete bladder emptying
5) hesitancy
6) dysuria
7) infection symptoms (malaise, fever, septicaemia)

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11
Q

Give 3 abdominal examination findings that support diagnosis of urinary tract obstruction:

A

1) loin tenderness
2) enlarged hydronephrotic kidney (palpable)
3) enlarged bladder

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12
Q

Give 2 examinations used to assess prostatic obstruction and pelvic malignancy in urinary tract obstruction:

A

1) genitalia exam
2) rectum exam

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13
Q

Name 6 investigations of urinary tract obstruction:

A

1) urinalysis (for haematuria)
2) midstream sample of urine (infection)
3) U+Es
4) ultrasound
5) X-ray (for stones)
6) CT scan (high sensitivity)

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14
Q

What is pyelography?

A

imaging of the kidneys

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15
Q

True or false: an obstructed and infected urinary tract is a medical emergency

A

true (delay can lead to septicaemia)

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16
Q

Give three treatments for hydronephrosis:

A

1) bladder/ suprapubic catheterisation
2) percutaneous nephrostomy
3) ureteric stent

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17
Q

Where is a suprapubic catheter inserted?

A

the abdominal wall above the symphysis pubis into the urinary bladder

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18
Q

Give one potential complication of relief of urinary tract obstruction:

A

massive diuresis may cause severe sodium, water and potassium depletion requiring IV replacement
(occurs in a minority of cases)

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19
Q

What are the most common types of kidney stones? (2)

A

1) calcium oxalate
2) calcium phosphate

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20
Q

What compound is found in struvite stones?

A

magnesium ammonium phosphate

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21
Q

Other than calcium stones, name three other types of nephrolithiasis:

A

1) struvite
2) uric acid
3) cystine

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22
Q

True or false: kidney stones rarely recur

A

false (more than 50% of patients will experience a second stone within 10 years of their first)

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23
Q

Describe why kidney stones form on a basic solute level:

A

solute concretions exceed saturation, particularly in dehydration

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24
Q

Give two causes of calcium stone formation:

A

1) hypercalcaemia/ primary hyperparathyroidism
2) hyperoxaluria

25
Q

Give 3 causes of hyperoxaluria:

A

1) ingestion of oxalate foods such as spinach, rhubarb and tea
2) GI disease such as Crohns associated with increased colon oxalate absorption
3) inborn errors of glyoxylate metabolism

26
Q

Give the two types of inborn errors of glyoxylate metabolism:

A

1) type 1: alanine-glyoxylate aminotransferase deficiency
2) type 2: glyoxylate reductase hydroxypyruvate reductase deficiency

27
Q

Give a cause of uric acid kidney stones:

A

hyperuricaemia

28
Q

Give two causes of hyperuricaemia:

A

1) idiopathic gout
2) myeloproliferative disorders (uric acid is the endpoint of purine synthesis)

29
Q

Describe how struvite stones are formed?

A

infection by bacteria like Proteus mirabilis hydrolyse urea to form ammonium hydroxide, favouring stone formation

30
Q

Give 3 examples of primary renal disease that can cause nephrolithiasis:

A

1) polycystic disease
2) medullary sponge kidney
3) renal tubular acidosis

31
Q

What is medullary sponge kidney?

A

Congenital dysplastic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia

32
Q

What is renal tubular acidosis?

A

decrease in either tubular H+ secretion or HCO3- reabsorption that leads to a non-anion gap metabolic acidosis

33
Q

Name 3 drugs that can cause calcium stones:

A

1) loop diuretics
2) antacids
3) glucocorticoids

34
Q

Give two drugs that can cause uric acid stones:

A

1) thiazides
2) salicylates (aspirin)

35
Q

Give two drugs that can precipitate into kidney stones:

A

1) indinavir
2) triamterene

36
Q

What is renal colic?

A

passage of the stone through the ureter.

37
Q

Give 3 ways renal colic can be managed:

A

1) analgesia
2) increased hydration
3) if the stone is more than 1cm, radiological or urological intervention may be needed e.g. extracorporeal shock wave therapy

38
Q

What is nephrocalcinosis?

A

A condition of calcium deposits within the renal parenchyma

39
Q

What is obstructive megaureter?

A

a childhood condition, only becoming evident in adult life where the ureter becomes wider due to the presence of a region of defective peristalsis at the lower end of the ureter

40
Q

Is obstructive megaureter more common in males or females?

A

males

41
Q

Give 3 symptoms of obstructive megaureter:

A

1) UTIs
2) flank pain
3) haematuria

42
Q

What is retroperitoneal fibrosis?

A

inflammatory fibrotic tissue encasing the aorta and ureters, compressing the ureter

43
Q

Is retroperitoneal fibrosis more common in males or females?

A

Males (x3)

44
Q

Give 4 presentations associated with retroperitoneal fibrosis:

A

1) lower back pain
2) weight loss
3) testicular pain
4) haematuria

45
Q

Give 3 lab findings that support diagnosis of retroperitoneal fibrosis:

A

1) anaemia
2) raised CRP
3) low GFR

46
Q

What imaging technique is used to view the peri-aortic mass seen in retroperitoneal fibrosis?

A

contrast-enhanced CT

47
Q

Give 3 management techniques for retroperitoneal fibrosis:

A

1) stenting of the ureters
2) corticosteroids
3) biopsy for underlying cause

48
Q

what is the most common type of urinary tract stone?

A

CALCIUM STONES

  • specifically calcium oxalate stones
  • mainly linked to hypercalciuria
49
Q

are calcium phosphate stones associated with low or high urine pH?

A

high

  • linked to renal tubular acidosis
50
Q

are uric acid stones associated with low or high urine pH?

A

low <5.5

  • caused by diseases resulting in excessive breakdown of tissue
51
Q

what causes struvite stones?

A

UTI

  • bacteria hydrolyses urea into ammonium > high urine pH >7.2
52
Q

what minerals form struvite stones?

A
  • magnesium
  • ammonium
  • phosphate
53
Q

what causes cystine stones?

A

a genetic disorder > cystinuria

54
Q

what are the risk factors of developing urinary tract stones?

A
  • obesity
  • dehydration
  • diets rich in oxalate (fruits, nuts and cocoa), urate, sodium and animal protein
  • FH
  • anatomical abnormalities in urinary tract
  • medical conditions eg hyperparathyroidism, renal tubular acidosis, myeloproliferative disorders and chronic diarrhoea
  • drugs
  • previous urinary tract stone
55
Q

what are the investigations for urinary tract stones?

A
  • urinalysis
  • urine MC+S
  • vital signs
  • FBC, U+Es, calcium and uric acid
  • non contrast CT = gold standard
56
Q

what investigation should be used for imagine urinary tract stones in pregnant women and children?

A

ultrasound

57
Q

what surgery is used for urinary tract stones <2cm?

A
  • extracorporeal shockwave lithotripsy (ESWL)
  • ureteroscopy (middle/distal ureteric stones and pregnant)
58
Q

what surgery is used for urinary tract stones >2cm?

A
  • percutaneous nephrolithotomy
  • open stone surgery (severe or above fails)
59
Q

what are the complications of urinary tarts calculi?

A
  • OBSTRUCTION OF URINARY FLOW > kidney damage or pyelonephrititis
  • renal carcinoma
  • CKD
  • rupture

Y3 - Renal (13 decks)

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