Urinary Tract Calculi

Question 1

Urinary tract calculi

AKA nephrolithiasis

Answer 1

More common in men
Average onset: 20-55 years
Increased incidence:
-white persons
-family history of stone formation
-previous history
-summer months

Question 2

When do we tend to see this?

Answer 2

During the warmer months and when hydration is an issue

Question 3

Etiology and patho

Answer 3

Stone formation

No single etiology for all cases

Question 4

Factors involved in stone formation

Answer 4

Metabolic
Genetic
Climate
Lifestyle
Occupational influences
Obstruction with urinary stasis
UTI

Question 5

Mucoprotein forms the matrix and is affected by

Answer 5

Urinary pH
Solute load
Inhibitors in urine

Question 6

The higher the pH…

Answer 6

calcium and phosphate are less soluble

alkaline

Question 7

The lower the pH

Answer 7

uric acid and cysteine are less soluble

acidic

Question 8

Calcium stones

Answer 8

From diet and dehydration
Alkaline
More common
Calcium phosphate
Calcium oxalate

Question 9

Calcium oxalate stones

Answer 9

More common

caused by high calcium and high oxalate excretion

Question 10

Calcium phosphate stones

Answer 10

caused by combination of high urine calcium and alkaline urine, meaning the urine has a high pH

Question 11

Uric acid stones

Answer 11

High purine diet (fish/meats)
Acidic
Forms when urine is persistently acidic

Question 12

Struvite stones

Answer 12

Magnesium ammonium phosphate

Result from kidney infections

Question 13

Cystine stones

Answer 13

Result from genetic disorder that causes cystine to leak through kidneys and into urine, forming crystals that tend to accumulate into stones

Question 14

Clinical manifestations

Answer 14

Sudden sever pain due to obstruction
Nausea and vomiting may accompany
Manifestations of UTI
Patients may be in mild shock with cool, moist skin

Question 15

Common sites of obstructions

Answer 15

Ureteropelvic junction (UPJ)
-Dull pain in costovertebral flank
-Renal colic
Ureterovesicular junction (UVJ)
-abdomen (lower quadrant)
-groin pain
-testicular/labial pain

Question 16

Renal colic

Answer 16

Term used for sharp, severe pain, which results from stretching, dilation, and spasm of ureter in response to obstructing stone
Pts have hard time sitting still

Question 17

Diagnostic studies

Answer 17

Noncontrast spiral CT (CT/KUB)
Ultrasonography
Intravenous pyelorgraphy (IVP)
Complete urinalysis including pH
Retrieval and analysis of stones
24 hour urine analysis

Question 18

Acute attacks

Answer 18

Treat pain (opioids)
Infection
Obstruction 
-tamsulosin
-terazosin

Question 19

Preventing further stone development

Answer 19

Pt and family history
Geographic residence
Nutritional assessment
Activity patterns
Immobilization or dehydration
Surgery of GI or GU tract
Drugs for prevention

Question 20

Collaborative care

Answer 20

Drugs
Endurologic procedure
-cystoscopy, ureteroscopy
Percutaneous nephrolithotomy
Lithotripsy
Surgical therapy
-Nephrolithotomy
-Pyelolithotomy
-Ureterolithotomy
-Cystotomy

Question 21

Nutritional therapy

Answer 21

Adequate fluid intake
Forcing fluids is contraindicated!
Limit colas, coffee, tea
Low-sodium diet
Decrease dietary intake of substances causing the stone type

Question 22

How much urine should you produce to ensure adequate fluid intake?

Answer 22

2 L of urine per day

Question 23

Home management

Answer 23

Strain all urine

Self-monitor urinary pH

Question 24

Lithotripsy

Answer 24

Shock/laser therapy to break stones

Question 25

At what size can you let patient pass a stone?

Answer 25

<6mm

Question 26

At what size do you go in and get stone out of patient?

Answer 26

> 6mm