Nephrolithiasis (7/19) (done) Flashcards
Path, Dx, Medical management
Most common mineral in stone?
Most common type of stone?
Calcium (80%)
Calcium oxalate (80%)
Primary hyperpara and RTA: what kind of stones?
Occurs when the urine pH is higher
If you see a uric acid stone, what kind of condition should you think of?
Which sex is more at risk for struvite stones? why?
Urinary risk factors for calcium stone diease (name 5 - figure)
What are some serum lab values that you should look for with your first stone episode?
(figure)
You will potentially find low magnesium and phosphate with high uric acid
What urine pH levels are associated with which kinds of stones? (figure)
RMR: UrAc stones = look for DM
What are some medication is associated with stones? (figure)
On a litholink, when do you send patient’s for genotyping or further specialized urine testing?
(figure)
Why does citrate prevent kidney stones?
Citrate binds to calcium in the urine and prevents hypercalciuria
Should you be on a high or low calcium diet if you have kidney stones?
What other dietary changes?
High calcium diet is recommended for prevention (800-1200mg/day)
(it’s an oxalate binder in the G.I. tract)
Low protein and low salt
What medications should you give to decrease the risk of calcium oxalate stones?
Why does it work?
(figure)
Reduction of urine calcium in hypercalciuria
How should you treat hypocitraturia?
Potassium citrate over sodium citrate
Distal RTA characteristics: AB disorder and K level, urine studies and pH, stones, treatments
(figure)
What surgical procedure can give you hyperoxaluria?
gastric bypass (fat malabsorption)
Uric acid stones form in low or high urine pH?
low urine ph
Treatment for uric acid stones? (figure)
Difficulties alkalinizing include bowel disease such as Crohn’s disease
Treatment for struvite stones? What bugs? What do the crystals look like? (figure)
Coffin shaped
we use the acid very infrequently
Hereditary causes of kidney stones with CKD? (figure)
What is the condition?
Cystinuria
Cystine is poorly soluble in the urine so it precipitates into crystals and those crystals grow into stones
Occurs in low urine pH
Proximal cystine reabsorption is impaired
(COLA: cystine, ornithine, arginine, lysine)
What is the treatment for cystinuria? (figure)
goal ph > 7.5
Medullar nephrocalcinosis - what disease is this associated with? (figure)
Dent disease can cause what? What is the genetic mutation?
Medullary nephrocalcinosis
CLCN5
What should you suspect if there is low GFR and big stone burden?
(figure)
Also, dent disease, but mostly hyperoxaluria
What is APRT deficiency? What kinds of stones? what do they look like?
Dihydroxyadenine stones
Treatment for APRT definicency? What do you fine on path?
Allopurinol
brown lamellated crystals
Treatment for APRT definicency? What do you fine on path?
Allopurinol
brown lamellated crystals
What are some stones not visualized by CT scan?
Topiramate and stones (figure)
Hypercalciuria, hypercalcemia, and calcium stones with low PTH - what should you suspect?
What is the importance of the CYP24A1 exzyme?
(figure)
calcitriolic acid is an inactive form of vit D
