Urolithiasis

Question 1

When should you treat a new kidney stone?

Answer 1

metabolically active stone disease, passing gravel, multiple stones

Question 2

Describe the stereotypical kidney stone patient?

Answer 2

old white men

Question 3

Name the top 4 causes of hematuria?

Answer 3

1 idiopathic (usu glomerular disease)
2 UTI
3 kidney stone
4 bladder, kidney, or prostate cancer

Question 4

What is the next step after finding red supernatant after spinning the urine?

Answer 4

check for heme via dipstick test

Question 5

What is the source of clots in the urine?

Answer 5

extra-glomerular source

Question 6

If your patient has hematuria after a recent URI, what is the most likely cause?

Answer 6

Ig (A) nephropathy

Question 7

If your patient has hematuria with concurrent pyuria and dysuria, what is the most likely cause?

Answer 7

UTI

Question 8

How would you treat a child whose only symptom is hematuria with no proteinuria?

Answer 8

watchful waiting

Question 9

What are the two possible causes for persistent hematuria in a child?

Answer 9

glomerulopathy or hypercalciuria

Question 10

What are some causes of an isolated incidence of hematuria in children?

Answer 10

interstitial tubular disease, UTI, stones, cancer, vascular disease, trauma, irritation of genitals

Question 11

If your patient has a history of recurrent kidney stones, what test would you run to confirm a diagnosis of kidney stone? First time stone?

Answer 11

ultrasound, KUB x-ray or CT scan

Question 12

What can cause false positive in urine dipstick testing?

Answer 12

alkaline urine, oxidizing agents

Question 13

What is the most common type of stone?

Answer 13

calcium oxalate

Question 14

What are the most common risk factors for developing a CaOx stone?

Answer 14

hypercalciuria, hyperoxaluria, hypocitraturia, increased uric acid excretion, low urine volume, primary hyperparathyroidism, RTA, medullary sponge kidney

Question 15

What are non-pharmacological treatments/preventions for CaOx kidney stones?

Answer 15

Increased fluid/Ca intake, decreased salt/protein/oxalate

Question 16

If you live in a hot/arid climate, what type of kidney stone are you most susceptible to?

Answer 16

uric acid stones (not visible on x-ray)

Question 17

Name two organisms that cause struvite stones

Answer 17

Klebsiella or Proteus mirabilis

Question 18

How would you treat a struvite kidney stone?

Answer 18

1 prophylactic abx (high risk)
2 acetohexemic acid (urease inhibitor)
3 ESWL

Question 19

You see a fuzzy stone in the kidney region on your patient’s x-ray. What is it most likely to be?

Answer 19

cysteine kidney stone

Question 20

For which type of kidney stones would you consider a renal transplant?

Answer 20

cysteine (AR genetic sub-type: impaired cysteine transport)

Question 21

What are some of the risks of ESWL?

Answer 21

damage to tubules/vessels, impaired renal fxn, stoen formation from residual calculi esp. struvite