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Urolithiasis Flashcards

1
Q

Define Nephrolithiasis

A

Stones in the kidney, ureter, or bladder of the urinary tract

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2
Q

1st Phenomena of Pathophysiology of Stones

A

Supersaturation of urine by stone-forming constituents

Crystals or FB can act as a nidus

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3
Q

2nd Phenomena of Pathophysiology of Stones

A

More likely responsible for calcium oxalate stones
Deposit of stone material on a a renal papillary calcium phosphate nidus
Calcium phosphate precipitates the basement membrane & erodes interstitium & accumulate in sub epithelial space
Subendothial deposits erode through the papillary urothilium
Stone matrix, calcium phosphate, & calcium oxalate deposit on nidus to create stone

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4
Q

Etiology of Nephrolithiasis

A

Low fluid intake with low volume of urine production

Hypercalcuria

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5
Q

Reasons for Hypercalcuria

A

Increase in intestinal absorption of calcium
Excess reabsorption of calcium from bone
Inability of renal tubules to properly reclaim calcium in glomerular filtrate

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6
Q

Types of Stones

A 
Calcium
Uric acid
Cystine
Struvite
Xanthine
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7
Q

Risk Factors of Nephrolithiasis

A

Family history
Gout
Primary hyperparathyroidism

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8
Q

Age for Highest Risk of Nephrolithiasis

A

Most: 20-49 years old
Peak: 35-45 years old

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9
Q

Clinical Presentation of Nephrolithiasis

A 
Pain
Infection
Hematuria
Acute onset severe flank pain radiating into the groin
Gross/microscopic hematuria
N/V
Fever/chills
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10
Q

Workup of Nephrolithiasis

A

UA: hematuria, bacteria or leukocytes
CBC: elevated WBCs
CMP: electrolytes, BUN/Cr levels, parathyroid hormone level with ionized calcium level
24 hour urine: identify urinary risk factors
Imaging: KUB, renal US, CT without contrast

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11
Q

Most Common Findings on 24 Hour Urine

A

Hypercalcuria
Hyperoxaluria (oxalate)
Hyperuricosuria (uric acid)
Hypocitraturia (citrate)

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12
Q

What does the 24 hour urine evaluate?

A 
Volume
pH
Calcium
Sodium
Phosphate
Citrate
Uric acid
Cystine
Oxalate
Magnesium
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13
Q

KUB & Nephrolithiasis

A

Good for: monitoring stones, large stones, radiopaque stones
Less radiation
Inexpensive

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14
Q

Renal Ultrasound & Nephrolithiasis

A

Good for diagnosing hydronephrosis
Difficult to see ureteral stones
No radiation
Test of choice for pregnancy

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15
Q

CT & Nephrolithiasis

A

Gold standard for stones

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16
Q

Treatment of Nephrolithiasis Depends on

A 
Stone size
Infection with obstructing stone
Solitary kidney
Pregnancy
Patient preference
Surgery
Medication
Diet
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17
Q

Stone Size & Treatment of Nephrolithiasis

A

8mm 0-10% passage on own

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18
Q

Infection with Obstructing Stone & Treatment of Nephrolithiasis

A

CONSULT UROLOGIST
Needs ureteral stent placement
Worry about sepsis

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19
Q

Solitary Kidney & Treatment of Nephrolithiasis

A

CONSULT UROLOGIST
Stent placement same day
Stone removal

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20
Q

Pregnancy & Treatment of Nephrolithiasis

A

Stent placement

Pain medication

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21
Q

Patient Preference & Treatment of Nephrolithiasis

A

Try to pass on won
Alpha-blocker (Flomax, Doxazosin)
NSAIDs & pain medication

22
Q

Surgical Treatment of Nephrolithiasis

A

Stent placement vs. percutaneous nephrostomy
Extracorporeal Shockwave Lithotripsy (ESWL)
Uteroscopoy
Percutaneous Nephrostolithotomy (PNL)
Open nephrostomy

23
Q

Medication Treatment of Nephrolithiasis

A 
Flomax
IM/IV Ketorolac
Hydrocodone or oxycodone
IM/IV metoclopramide
Morphine
NSAIDs
24
Q

Diet in Treatment of Nephrolithiasis

A

Increase fluids
Avoid excess salt & protein intake
Moderation in food high in oxalate
Do NOT limit calcium

25
Foods High in Oxilate
Green leafy vegetables Chocolates Tea
26
Calcium Oxalate Stones
Most common stone | Formation caused by high calcium & high oxalate excretion
27
Uric Acid Stones
Most common radiolucent stone | Low urine volume and acidic urine pH promote precipitation of uric acid
28
Describe Calcium Oxalate Crystals
Diamond looking
29
Describe Uric Acid Crystals
Flattened hexagonal appearing
30
Cystine Stones
Genetic cause of kidney stones | White pearly looking stones
31
Describe Cystine Crystals
Hexagonal shaped
32
Struvite Stones
Grow rapidly over weeks or months Grow into stag horn calculus Caused by UTI: urease-producing organism
33
Urease-Producing Organisms
Proteus | Klebsiella
34
Xanthine Stones
Rare Caused by inborn defect of xanthine oxidase Xanthine cannot be oxidized to uric acid
35
Hypercalciuria
Common cause is idiopathic Thiazide therapy can lower calcium excretion Decrease sodium intake
36
Hyperoxaluria
Intestinal hyper-absorption | Increase consumption
37
Hyperuricosuria
Elevated urinary excretion of uric acid | Promotes calcium oxalate stone formation
38
Medications for Hyperuricosuria
Allopurinol: reduce calcium stones | Potassium citrate: raise pH, dissolves stones
39
Outpatient Refer to Urology
Stone >5 mm | Failure to pass symptomatic stone after conservative management
40
Treatment of Outpatient Nephrolithiasis
``` Stent placement Extracorporeal shock wave lithotripsy (ESWL) Ureteroscopic lithotripsy Percutaneous nephrolithotomy Laparoscopic stone removal ```
41
Urgent Inpatient Referral to Urology
``` Urosepsis Intractable pain Bilateral obstructing stones Acute renal failure Anuria ```
42
Define Bladder Stones
Hard buildups of minerals that forming the urinary bladder
43
Most Common Bladder Stone
Uric acid stones
44
Surface of Bladder stones
Smooth & faceted | Jagged & spiculated
45
Risk Factors of Bladder Stones
``` Bladder diverticulum Bladder outlet obstruction (most common) Neurogenic bladder UTIs Catheters ```
46
Presentation of Bladder Stones
``` Abdominal pain/pressure Hematuria or dark colored urine Difficulty urinating Urgency/frequency Interruption of stream Penile discomfort UTI ```
47
Physical Exam for Bladder Stones
Rectal exam: large prostate Bladder or pelvic x-ray Cystoscopy UA with culture
48
Treatment of Bladder Stones
Cystoscopy in office for small stones Surgery: cystolithalopaxy, cystolithotomy, TURP, simple prostatectomy Medical: potassium citrate (Urocit K)
49
Cystolithalopaxy
Uses laser to break them up and pull it out through the scope
50
Cystolithotomy
Don't break up the stones | Make an incision & remove the stones

Urology (12 decks)

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