Urolithiasis Flashcards
How likely are kidney stones to recur if you’ve had them once?
very likely
What are some risk factors for stone development?
decreased water intake, sedentary lifestyle, living in a hot area, history of stones
What is the clinical presentation of someone with stones?
If stone is still in the kidney–> they may appear asymptomatic. However, once it starts passing into the ureter, then extreme pain develops in flank and radiates to lower abdomen. Patients are restless, ambulatory, n/v, hematuria, and may experience mirror pain.
does the size of stone correlate to the amount of pain?
no!!!
pain tends to decrease once the stone passes into the…
bladder!
What might your ddx be for a kidney stone?
pyelonephritis, cystitis, bladder cancer, STD, acute abdomen.
How will the patient appear on physical exam?
general: patient ambulatory, unwell
vitals: r/o fever, may have increased bp due to pain
abdomen: pain that radiates there? n/v
GU: check CVA tenderness, can’t pee? painful pee? hematuria, r/o stds by checking for discharge, masses etc. tip of penis may have pain
What is the gold standard for diagnosis of a kidney stone?
spiral CT
What are some other imaging techniques that may be used to ID a stone? What should you use if someone is also pregnant?
plain abdominal film, IVP, U/S, spiral CT. If pregnant, use an ultrasound
What stones are radio opaque? What stones are radiolucent?
RO= calcium stones. RL= uric acid
What will your lab findings show?
usually reveals hematuria. YOU MUST EXCLUDE INFECTION (so make sure there is no bacteria).
What does pH tell you about stone type?
acidic pH forms uric acid stones. alkaline urine forms calcium stones. both TEMP and pH AFFECT stone formation!! a pH below 5.5 suggests uric or cysteine. a pH greater than 7.2 suggests struvite, and calcium based are typically between 5.5 and 6.8
What additional lab testing might be helpful to R/O other problems or causes?
serum BUN, serum creatinine, calcium, phosphorus, uric acid, PTH is hypercalcemic.
Stone Passage:
80-90% of stones pass on their own. 4 things to instruct patient:
- increase fluid intake
- strain urine to catch stone
- analgesic
- facilitate passage with CCB or alpha blocker (nifedipine/tamsulosin).
How do you know if you need to hospitalize someone for a kidney stone?
fever, uti, oral analgesic ineffective, intractable vomiting and dehydration.
If the stone DOES NOT pass on its own, what you are treatment options…
start to consider these after a few weeks.
- shock wave lithrotripsy
- percutaneous nephrostoithotomy
- ureterscopy
- open stone surgery.
When should you refer??
evidence of obstruction, anatomic abnormalities, or solitary kidney, uti, fever
What diet changes should the patient make?
increased fluid (patient should be voiding around 1.5-2L a day), restrict sodium intake, decreased animal protein, get calcium from DIET
What is the risk factors for UTI
sweating, excessive sun exposure, recurrent UTI (struvite stones), neurogenic bladder (struvite), gout (uric acid), chronic diareaah, family history
what medications put you at a higher risk of developing stones?
carbonic anhydrase inhibitors, triamterene, sulfadiazine, ascorbic acid, indinavir, topamax, acetazolamide
what medication could decrease your risk of stone formation?
thiazides, that increase Ca uptake in the BODY instead of putting it into the URINE.
What are some dietary measures that decrease calcium stone formation?
coffee, tea, beer, wine. (colas made no difference).
Describe the medical management of uric acid stones?
alakanalize the urine to ph of 6-6.5. give potassium citrate, increase fluid intake, and restrict purines.
Name several different types of stones?
Calcium based (calcium oxalate/phosphate is most common)
Uric Acid
Struvite
Cystine
What is unique about struvite stones?
they usually come about due to recurrent UTIs caused by klebsiella or proteus species, and cause the development of ammonia. Usually develop into stag horn caliculi.
what does the calcium oxalate stones look like?
colorless, 8 sided envelope
what does the uric acid stones look like?
yellow or reddish brown, diamond shaped or six sided
what does the cystine crystals stones look like?
colorless hexagon shaped
This condition can cause repeat nephrolithiasis, specifically if stones are found to be calcium based. Lab studies show increased PTH.
primary hyperparathyroidism
