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Urology > Urolithiasis > Flashcards

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
Q

Foods High in Oxilate

A

Green leafy vegetables
Chocolates
Tea

26
Q

Calcium Oxalate Stones

A

Most common stone

Formation caused by high calcium & high oxalate excretion

27
Q

Uric Acid Stones

A

Most common radiolucent stone

Low urine volume and acidic urine pH promote precipitation of uric acid

28
Q

Describe Calcium Oxalate Crystals

A

Diamond looking

29
Q

Describe Uric Acid Crystals

A

Flattened hexagonal appearing

30
Q

Cystine Stones

A

Genetic cause of kidney stones

White pearly looking stones

31
Q

Describe Cystine Crystals

A

Hexagonal shaped

32
Q

Struvite Stones

A

Grow rapidly over weeks or months
Grow into stag horn calculus
Caused by UTI: urease-producing organism

33
Q

Urease-Producing Organisms

A

Proteus

Klebsiella

34
Q

Xanthine Stones

A

Rare
Caused by inborn defect of xanthine oxidase
Xanthine cannot be oxidized to uric acid

35
Q

Hypercalciuria

A

Common cause is idiopathic
Thiazide therapy can lower calcium excretion
Decrease sodium intake

36
Q

Hyperoxaluria

A

Intestinal hyper-absorption

Increase consumption

37
Q

Hyperuricosuria

A

Elevated urinary excretion of uric acid

Promotes calcium oxalate stone formation

38
Q

Medications for Hyperuricosuria

A

Allopurinol: reduce calcium stones

Potassium citrate: raise pH, dissolves stones

39
Q

Outpatient Refer to Urology

A

Stone >5 mm

Failure to pass symptomatic stone after conservative management

40
Q

Treatment of Outpatient Nephrolithiasis

A 
Stent placement
Extracorporeal shock wave lithotripsy (ESWL)
Ureteroscopic lithotripsy
Percutaneous nephrolithotomy
Laparoscopic stone removal
41
Q

Urgent Inpatient Referral to Urology

A 
Urosepsis
Intractable pain
Bilateral obstructing stones
Acute renal failure
Anuria
42
Q

Define Bladder Stones

A

Hard buildups of minerals that forming the urinary bladder

43
Q

Most Common Bladder Stone

A

Uric acid stones

44
Q

Surface of Bladder stones

A

Smooth & faceted

Jagged & spiculated

45
Q

Risk Factors of Bladder Stones

A 
Bladder diverticulum
Bladder outlet obstruction (most common)
Neurogenic bladder
UTIs
Catheters
46
Q

Presentation of Bladder Stones

A 
Abdominal pain/pressure
Hematuria or dark colored urine
Difficulty urinating
Urgency/frequency
Interruption of stream
Penile discomfort
UTI
47
Q

Physical Exam for Bladder Stones

A

Rectal exam: large prostate
Bladder or pelvic x-ray
Cystoscopy
UA with culture

48
Q

Treatment of Bladder Stones

A

Cystoscopy in office for small stones
Surgery: cystolithalopaxy, cystolithotomy, TURP, simple prostatectomy
Medical: potassium citrate (Urocit K)

49
Q

Cystolithalopaxy

A

Uses laser to break them up and pull it out through the scope

50
Q

Cystolithotomy

A

Don’t break up the stones

Make an incision & remove the stones

Urology (12 decks)

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