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Renal Systems > WK 7 Kidney Stones > Flashcards

WK 7 Kidney Stones Flashcards

1
Q

Kidney Stones DNT:

Stone composition

A
  • 2/3 are made from calcium oxalate

* Uric acid most common non-calcium stone

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2
Q

Kidney Stones DNT:

Evaluation

A
  • Chemical stone composition analysis, if possible
  • 24 hour urine collection
  • Ultrasound, if stone <4mm 80% pass. >8mm 20% pass
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3
Q

Kidney Stones DNT:

Risk factors

A
  • Reduced fluid intake

* Aim for 2L+ urine output daily

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4
Q

Kidney Stones DNT:

Calcium stones Diet recommendation:

A
  • Diet recommendation to reduce salt & protein in diet
  • Old style low calcium diet: tough to do d/t bone loss risk, unintended effect of increase absorption of dietary oxalates, calcium supplements are associated w/ 20% increase in stone risk
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5
Q

Kidney Stones DNT:

Hypercalcuria

A
  1. Consider thiazide diuretics (inhibit calcium absorption)
  2. Screen PTH
  3. Consider low calcium diet if diagnosed hypercalcuria.
    * *Target 600-800 mg/day = 1 dairy meal + calcium from lesser sources
    * *Limit dietary oxalates
  4. Other therapies: bisphosphonates, estrogen therapy
  5. Meds that can cause hypercalcuria: corticosteroids, vitamin D, aluminum antacids, loop diuretics
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6
Q

Kidney Stones DNT:
Hypocitraturia

*Diets

A
  1. 320 mg standard reference range, some researchers suggest <600 is too low for stone formers
  2. Can induce either oxalate or phosphate stones
  3. Diets high in protein & low in carbs can reduce urine citrate
  4. Diets high in sodium suppress citrate excretion
  5. Diets rich in potassium salts increase urine pH
  6. Diets rich in natural citric acid may enhance treatment efficacy
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7
Q

Kidney Stones DNT: Hyperoxaluria
Urine output?
Sources?

A
  1. Urine output >40 mg/day
  2. Sources: plant foods, chocolate, nuts, spinach
  3. Vitamin B6 reduce levels, magnesium will potentiate effect
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8
Q

Kidney Stones DNT: Struvite stones

  • Assoc w/??
  • Treat what?
A
  1. Magnesium ammonium phosphate stones
  2. Precipitate from alkaline urine
  3. Associated w/ chronic UTI (gram negative rods)
  4. Treat the infection, image quickly (frequently impact & need surgery)
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9
Q

Kidney Stones DNT: Uric acid stones

*Related cond’s?

A
  1. Radiolucent stones, precipitate from an acidic urine
  2. Related to conditions (leukemia, diabetics etc.)
  3. High does enzymes, ketogenic diet & thiazide diuretics increase risk
  4. Dehydration risk factor
  5. Orange to red diapers can be clues about uric acid stones in infants
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10
Q

Kidney Stones DNT: Uric acid stones Management:

A
  1. Alkalinization & dilation of urine
  2. Citrate or bicarb to increase pH to 6.5-7
  3. Urine output 30 ml/kg/day
  4. Low purine diet
  5. Remove urine uric acid forming medictions
  6. Consider xanthine oxidase inhibitors (patients w/ hyperuricemia)
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11
Q

Kidney Stones DNT: Cysteine stones

A
  1. Low methionine diet may be useful, but hard to do (legume based protein sources, potassium rich foods)
  2. D/t metabolic defect of tubular reabsorption of cysteine
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12
Q 
*Vitamin B12:
Biochemistry: 
Sources: 
Metabolism:
Functions: 
Major uses:
A

Biochemistry: methylation pathway
Sources: bacteria & fungi product. Fermented foods, nutrition yeast, fortified foods, fish, spiruline (some data)
Metabolism: stores for long periods, large & complex molecule
Functions: make hemoglobin, methylation, normal DNA replication
Major uses: pernicious anemia, fatigue, anxiety, depression, insomnia

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13
Q 
*Vitamin B12:
Other uses: Dz's
Dosing: 
Toxicity: 
Deficiency risk &amp; testing: 
Interactions:
A
  1. Other uses: tinnitus, diabetic retinopathy, diabetic neuropathy, neurologic disorders, dementia, asthma, HIV, MS, migraines, cyanide poisoning
  2. Dosing: 2-10 mcg/day. Sublingual preparations not better than oral. IM given every week to month
  3. Toxicity: none really
  4. Deficiency risk & testing: risk is low in US, higher risk for vegetarians & vegans
  5. Interactions: antacids & acid lowering drugs impair absorption. Metformin impair absorption.
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14
Q 
**PABA (Para-Aminobenzoic Acid):
Biochemistry: 
Sources: 
Major uses: 
Other uses: Dz's 
Toxicity: 
Interactions:
A
  1. Biochemistry: part of B complex, center part of folic acid. Intestinal microbes require PABA for growth
  2. Sources: grains, eggs, milk, meat
  3. Major uses: sunscreen
  4. Other uses: autoimmune diseases, CT disorders, fibrotic conditions, infertility, pemphigus vulgaris, darkening grey hair
  5. Toxicity: topical can cause allergic symptoms, large doses can cause hypoglycemia
  6. Interactions: sulfa drugs deplete PABA
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15
Q 
Kidney Stones DNT:
Hypocitraturia Medication treatment:
1. Preferred choice
2. PH
3. SE
4. ContraIndications
A

Medication treatment:

  • *Potassium citrate is preferred choice
  • *Titrate and check at 4 months
  • *Keep pH <7.2 but >5
  • *SE: upper & lower GI (1/2 d/c treatment)
  • *CI: kidney disease (stage 4 or 5)
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Renal Systems (11 decks)

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