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Urolithiasis Flashcards

1
Q

This is the term used to describe the dilation of the renal pelvis and calyces and progressive atrophy of the kidney.

A

Hydronephrosis

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2
Q

What causes hydronephrosis?

A

Obstruction

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3
Q

What is the most common cause (70%) of renal calculi?

A

Calcium stones (Ca oxalate/phosphate)

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4
Q

Do you see calcium oxalate stones on radiographs?

A

yes

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5
Q

True or False: calcium stones is usually assocaited with hypercalcuria from hypercalcemia.

A

FALSE. 55% dont have hypercalcemia

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6
Q

Is there increased or decreased uric acid secretion with Ca stones?

A

Increased

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7
Q

5% of pts with Ca stones can have hypercalcemia AND hypercalciuria because of what conditions?

A

hyperPTH, diffuse bone disease, sarcoidosis

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8
Q

What are the 3 ions in triple/struvite stones?

A

Mg, Ammonium, Phosphate

MAP stones

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9
Q

What is the typical etiolgoy for struvite stones?

A

Following infections by urease + bacteria (proteus and staph) that convert urea to ammonia

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10
Q

What do you see in the renal pelvis in struvite stones?

A

Staghorn calculi

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11
Q

Do you see struvite stones on radiogrpahs?

A

Yes

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12
Q

Hyperuricemic conditions like gout can cause what type of stones in the urinary tract?

A

Uric acid stones

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13
Q

Do you see uric acid stones on radiographs?

A

NO

it’s the only one you can’t see. they;re radioLUCENT

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14
Q

True or False: most uric acid stones has neither hyperuricemia nor increased urinary excretion of uric acid.

A

True (> 50%)

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15
Q

Genetic defects in renal reabsorption of amino acids can lead to what type of stones?

A

Cystine stones

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16
Q

Which stones are more dangerous, large or small?

A

Small (ureteral obstruction)

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17
Q

Since large stones remain in the renal pelvis, what is the first sign of presence of large stones?

A

Hematuria

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18
Q

Which type of stone is pH independent?

A

Ca oxalate

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19
Q

What 2 conserative treatments what eliminates stone-forming tendencies in 70% of patients?

A

Diet and increased fluid intake

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20
Q

What % of all stones are uric acid stones?

A

10%

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21
Q

75% of uric acid stones have what kind of pH of the urine?

A

persistently low urine pH

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22
Q

Do 75% of uric acid stone pts have normal or abnormal levels of uric acid in the serum and urine?

A

Normal

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23
Q

What pts are 3x more likely to develop uric acid stones?

24
Q

What % of primary gout pts get renal stones?

25
Excess intake of what substance can lead to uric acid stones?
PROTEIN
26
In addition to prevenative Tx, what change in urine pH do you want to Tx uric acid stones?
Alkalizing the urine to a pH of 6.5
27
Which drug can help patients with hyperuricosuria and dissolving stones?
Allopurinol
28
What is the 2 treatments for struvite stones?
Antibiotics preop and then surgical removal
29
Is the urine pH usually high or low in struvite stones?
High
30
What % of struvite stones occur b/l?
50%
31
If Ca absorption in the gut exceeds excretion in the urine or there's a defect in Ca reabsorption, what can happen to Ca levels in the urine?
Hypercalciuria
32
What can cause hypericosuria?
increased uric acid secretion and "nucleation" of Ca oxalate by uric acid crystals in the CD
33
What can leads to hyperoxaluria?
Intestinal overabsorption of oxalates
34
Acidosis and chronic diarrhea can lead to what change in citrates in the urine?
Hypociraturia
35
So hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitrauria cna lead to the formation of which stones?
Calcium stones
36
Proteus, Pseudomonas, and Klebsiella cause which stones?
Struvite stones
37
At what urine pH does uric acid stones from?
pH < 5.5
38
Why can uric acid stones form in malignancy, like in leukemias?
Rapid cell turnover
39
What 2 classes of drugs are used for tha management to pain in renal colics?
NSAIDs and narcotics
40
Which narcotics do you use if the pt can tolerate oral administration?
A combo of narcotics (codeine, oxycodone, hydrocodone, all with acetaminophen)
41
If the pt cannot handle oral administration, what is the narcotic drug of choice for renal colics?
Morphine
42
What is the NSAID drug of choice for renal colics?
Ketorolac (parenteral)
43
What is the Ca++ channel blocker that is used in combination with prednisolone that facilitates the passage of a ureteral stone?
Nifedipine
44
This is the alpha-1 blocker that is used in the treatment of BPH and facilitates the passage of ureteral stones because it's a smooth muscle relaxer.
Tamsulosin
45
What is the other alpha-1 blocker that is a smooth muscle relaxer and used for both HTN and faciliates the passage of a ureteral stone?
Terazosin
46
Which enzyme does allopurinol inhibit to help prevent recurrent calcium oxalate calculi?
Xanthine oxidase
47
Which substance does xanthine oxidase use to synthesize uric acid?
Hypoxanthine
48
What are the 2 thiols that are can break the disulfide bridge and forma more soluble complex with monomeric cysteine?
Tiopronin and D-penicillamine
49
After trying what therapies do you use tipronin and D-penicillamine?
Fluid loading, salt reduction, and alkali therapy
50
What are the 5 hematologic abnormalieis seen with tiopronin and D-penicillamine?
Bleeding, anemia, leukopenia, thrombocytopenia, and eosinophilia
51
What is the major nuerological complication seen with tiopronin and D-penicillamine?
Myasthenic syndrome
52
Why does giving Potassium citrate and lecomonade help treat Ca containing stones?
Citrate complexes with Ca in the urine and lowers the urinary supersaturation of Ca
53
Which transporter does thiazides inhibit?
Na/Cl symporter at the DCT
54
Thiazides subsequently increase the reabsorption of which ion from the urine?
Ca++
55
So thiazides treat which 4 hypercalciuria conditions?
1. Absorptive hypercalciuria (↑ gut) 2. Renal phosphate lead hypercalciuria (vit D) 3. Renal leak hypercalciuria (↓ renal reabs) 4. Resorptive hypercalciuria (↑ PTH)
56
This is the K+ sparing diuretic that is normally used in combo with a thiazide, but is hihgly insoluble in urine and may increase the incidence of stone formation.
Triamterene
57
What K+ sparking diuretic is used instead of Triamterene in the preventative treatment of kidney stones?
Amiloride

Renal Too (3 decks)

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