urologic problems: nephrolithiasis

Question 1

what parts of the urinary system can become obstructed?

Answer 1

urethra
ureters
bladder
kidneys (renal pelvis)

Question 2

renal pelvis

Answer 2

where urine is collected and drained to ureters

Question 3

what factors determine how destructive an obstruction is?

Answer 3

degree
location (closer to kidneys = worse)
duration
timing

Question 4

what causes destruction of the renal pelvis?

Answer 4

renal calculi (kidney stones)

Question 5

what causes destruction of the ureter?

Answer 5

renal calculi (kidney stones)
pregnancy
tumors

Question 6

what causes destruction of the bladder and urethra?

Answer 6

bladder cancer
neurogenic bladder
prostatic hyperplasia
prostate cancer
urethral strictures

Question 7

complications of an obstruction

Answer 7

stasis of urine flow (increase risk for infection)

back-up pressure
-hydroureter (dilation of ureters)
-hydronephrosis (dilation of renal pelvis)
-postrenal acute kidney injury

Question 8

manifestations of an acute obstruction depend on the…

Answer 8

site
cause
speed of onset

Question 9

what factor determines the severity of pain?

Answer 9

SITE - is it large enough for blockage? is the blockage internal (stones)? external (prosthetic hyperplasia)? Onset fast or slow?

Question 10

nephrolithiasis

Answer 10

renal calculi (kidney stones)
clumps of crystals in the urinary tract

Question 11

where do kidney stones form?

Answer 11

renal pelvis and migrate through urinary tract and can get stuck in bladder, urethra, ureter

Question 12

where are kidney stones located?

Answer 12

renal pelvis –> bladder –> urethra

Question 13

risk factors for nephrolithiasis

Answer 13

sex (men)
20-30s
white
family hx
congenital defect
obesity
weather (hot)

Question 14

how does weather affect nephrolithiasis?

Answer 14

hot weather –> increases risk for dehydration –> increases concentration –> increases formation of crystallized solutes clumping together

Question 15

cause of nephrolithiasis

Answer 15

crystallized solutes in the urine

depends on:
-individual risk factors
-characteristics of the urine (diet, medications)
-type of stone being formed

Question 16

types of kidney stones

Answer 16

calcium oxalate
struvite (“staghorn”)
uric acid

Question 17

calcium oxalate: incidence and specific risks

Answer 17

75%
-extreme pain

risks:
family hx
idiopathic
increase calcemia (Ca in blood)
increase oxaluria (oxalate in blood)

Question 18

struvite (“staghorn”): incidence and specific risks

Answer 18

staghorn: stay in renal pelvis
-can become very large
-no pain
-surgically removed

7-10%

risks:
UTI
(caused by bacteria breaking down products in urine)

Question 19

uric acid: incidence and specific risks

Answer 19

7-10%

risks: gout

Question 20

patho of nephrolitiasis

Answer 20

urine is a solution of solvent (water) and solutes (particles)

problem: super saturation with a solute
crystals begin forming in the nephron

Question 21

what increases the risk of nephrolithiasis?

Answer 21

dehydration
immobility/sedentary lifestyle

Question 22

clinical manifestations of acute renal colic

Answer 22

located in flank
radiates down along groin
spasms
intermittent, sharp pain

-N/V
-diaphoresis
-increase HR
-increase RR
*lower UTI symptoms (dysuria, hematuria, etc.)

Question 23

nephrolithiasis treatment for acute pain

Answer 23

morphine
NSAIDS
IV fluids (keep urine diluted + moving to push stones through)

Question 24

preventive meds for calcium oxalate

Answer 24

thiazide diuretics

Question 25

preventive meds for struvite

Answer 25

antibiotics

Question 26

preventive meds for urate/uric acid stones

Answer 26

allopurinol