Wk 9 Urolithiasis and Diet

Question 1

What is the primary action required to treat acute ureteral colic?

What agents: effectively provide this action?
Herbs, drugs, minerals, hydrotherapy, etc.)

Answer 1

1. Primary action is spasmolytic (will give pain control)
2. Herbs: amni visnaga, Piscidia piscipula, gelsemium sempervirens, hyoscyamus
3. Drugs: Alpha 1 blockers (tamsulosin-FLOMAX)
4. Minerals: Magnesium
5. Hydrotherapy: hot compress to back, hot bath

Question 2

What additional action is necessary to add to keep the stone moving?

Herbs:
Drugs:

Answer 2

Diuretic

1. Herbs: solidago, Taraxacum, urtica, apium, juniperus
2. Drugs: Thiazides (HTN & Edema), Loop diuretics (inhibit sodium- potassium-chloride)
3. Others: increase fluid intake

Question 3

What size stone can be safely passed?

Answer 3

<5 mm for calcium stones, uric acid stones can go through the dissolution program

Question 4

How are acute uric stones treated differently from other types?

Answer 4

1. Can be dissolved
2. pH 6.5-7
3. Vegetarian diet, w/ high fluid intake
4. Potassium citrate
5. Combine w/ spasmolytics & diuretics if ureteral colic

Question 5

What testing (for Colic) is indicated to develop an individualized prevention and treatment protocol? How is it interpreted?

Answer 5

A. 24 hour urine metabolic risk panel
B. Look at fluid intake, citrate, magnesium, oxalate, phosphate, calcium, uric acid, pH

1. If calcium high do 3 day calcium fast followed by 24 hour spot urine calcium
2. If hypocitrate: lemonade, potassium citrate, magnesium citrate w/ food
3. If hypomagnesium: magnesium replacement, high-mag foods
4. If hyperoxaluria: calcium & magnesium w/ foods. Avoid chocolate, figs, parsley, rhubarb, spinach, black tea, cinnamon, turmeric, black pepper.
5. If uricosuria: low purine diet, emphasize vegetables, high fluid, hibisucus, allopurinol
6. If hyperphosphate: avoid soda, dairy, deli meet

Question 6

How are struvite stones different from other stones?

Answer 6

1. Generally require surgical removal & antibiotics
2. Urine acidification helpful
3. Cranberry to prevent UTIs
4. Urea-splitting organisms (proteus, providencia or pseudomonas)

Question 7

How do hCT, ultrasound, and plain film KUB compare in assessment of kidney stones?

Answer 7

1. KUB: Sensitivity 97%; Specificity 58%; 1 mSv; miss uric acid stones
2. Ultrasound: Sensitivity 61%; Specificity 100%, no mSv; miss calcium stones
3. hCT: Sensitivity 96%, Specificity 100%; 7.5 mSv
4. Yarnell: if known history of calcium stone start w/ KUB. If low risk do either KUB or US. If results mixed can still do CT

Question 8

Review extracorporeal shockwave lithotripsy.

Answer 8

1. Probe inserted through urinary tract & extracorporeal shockwave lithrotripsy
2. Use astragalus in conjunction

Question 9

How are absorptive Hypercalciuria subtypes diagnosed & distinguished?

Calciuria evaluation:

Answer 9

Calciuria evaluation:

1. Pre-fast or spot 24 hour urine
2. 72 hour calcium fast
3. No decrease in urine calcium: type 1
4. Decrease in urine calcium: type 2 or 3
   a. Type 1: not diet responsive, treat w/calcium binders, thiazides.
   b. Type 2: low calcium diet.
   c. Type 3: Vitamin D blockers

Question 10

How are absorptive primary hyperparathyroidism diagnosed and distinguished?

Primary hyperparathyroid:

Answer 10

High Ca2+ and high/normal iPTH

Question 11

Review litholytic herbs.

Answer 11

• *Yarnell’s Handout Notes**
• *1. Eutrochium (Eupoatorium) purpureum (Joe Pye weed),
• *2. Rubia tinctoria (Dyer’s Madder),
• *3. Phyllanthus niruri (Chanca piedra),

4. Vigna unguiculata,
5. Orthosiphon stamineus,
6. Hibisucus,
7. Rosa