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Renal Too > Urolithiasis > Flashcards

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?

A

Diabetes

24
Q

What % of primary gout pts get renal stones?

A

25%

25
Q

Excess intake of what substance can lead to uric acid stones?

A

PROTEIN

26
Q

In addition to prevenative Tx, what change in urine pH do you want to Tx uric acid stones?

A

Alkalizing the urine to a pH of 6.5

27
Q

Which drug can help patients with hyperuricosuria and dissolving stones?

A

Allopurinol

28
Q

What is the 2 treatments for struvite stones?

A

Antibiotics preop and then surgical removal

29
Q

Is the urine pH usually high or low in struvite stones?

A

High

30
Q

What % of struvite stones occur b/l?

A

50%

31
Q

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?

A

Hypercalciuria

32
Q

What can cause hypericosuria?

A

increased uric acid secretion and “nucleation” of Ca oxalate by uric acid crystals in the CD

33
Q

What can leads to hyperoxaluria?

A

Intestinal overabsorption of oxalates

34
Q

Acidosis and chronic diarrhea can lead to what change in citrates in the urine?

A

Hypociraturia

35
Q

So hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitrauria cna lead to the formation of which stones?

A

Calcium stones

36
Q

Proteus, Pseudomonas, and Klebsiella cause which stones?

A

Struvite stones

37
Q

At what urine pH does uric acid stones from?

A

pH < 5.5

38
Q

Why can uric acid stones form in malignancy, like in leukemias?

A

Rapid cell turnover

39
Q

What 2 classes of drugs are used for tha management to pain in renal colics?

A

NSAIDs and narcotics

40
Q

Which narcotics do you use if the pt can tolerate oral administration?

A

A combo of narcotics (codeine, oxycodone, hydrocodone, all with acetaminophen)

41
Q

If the pt cannot handle oral administration, what is the narcotic drug of choice for renal colics?

A

Morphine

42
Q

What is the NSAID drug of choice for renal colics?

A

Ketorolac (parenteral)

43
Q

What is the Ca++ channel blocker that is used in combination with prednisolone that facilitates the passage of a ureteral stone?

A

Nifedipine

44
Q

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.

A

Tamsulosin

45
Q

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?

A

Terazosin

46
Q

Which enzyme does allopurinol inhibit to help prevent recurrent calcium oxalate calculi?

A

Xanthine oxidase

47
Q

Which substance does xanthine oxidase use to synthesize uric acid?

A

Hypoxanthine

48
Q

What are the 2 thiols that are can break the disulfide bridge and forma more soluble complex with monomeric cysteine?

A

Tiopronin and D-penicillamine

49
Q

After trying what therapies do you use tipronin and D-penicillamine?

A

Fluid loading, salt reduction, and alkali therapy

50
Q

What are the 5 hematologic abnormalieis seen with tiopronin and D-penicillamine?

A

Bleeding, anemia, leukopenia, thrombocytopenia, and eosinophilia

51
Q

What is the major nuerological complication seen with tiopronin and D-penicillamine?

A

Myasthenic syndrome

52
Q

Why does giving Potassium citrate and lecomonade help treat Ca containing stones?

A

Citrate complexes with Ca in the urine and lowers the urinary supersaturation of Ca

53
Q

Which transporter does thiazides inhibit?

A

Na/Cl symporter at the DCT

54
Q

Thiazides subsequently increase the reabsorption of which ion from the urine?

A

Ca++

55
Q

So thiazides treat which 4 hypercalciuria conditions?

A
  1. Absorptive hypercalciuria (↑ gut)
  2. Renal phosphate lead hypercalciuria (vit D)
  3. Renal leak hypercalciuria (↓ renal reabs)
  4. Resorptive hypercalciuria (↑ PTH)
56
Q

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.

A

Triamterene

57
Q

What K+ sparking diuretic is used instead of Triamterene in the preventative treatment of kidney stones?

A

Amiloride

Renal Too (3 decks)

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