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Adult/Ped Medicine 6 > Urolithiasis - Thierfelder > Flashcards

Urolithiasis - Thierfelder Flashcards

1
Q

Patient reports with severe flank pain radiating to the lower abdomen, groin, testes. Patient also has hematuria. What are these symptoms for?

A

Kidney Stones- can be asymptomatic, cause restlessness, nausea, vomiting, ileus, “mirror pain”

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2
Q

Renal Colic

A
  • severe flank pain radiation to lower abdomen, groin, or testes
  • restless, ambulatory
  • nausea, vomiting, ileus
  • mirror pain
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3
Q

Urolithiasis Stone Presentation

A
  • asymptomatic
  • acute urinary obstruction - renal colic
  • hematuria
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4
Q

Stone Ingredients

A 
Calcium
Oxalate
Phosphate
Uric Acid
Cystine
Struvite
Triameterne
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5
Q

________ and _________ inhibit nucleation

A

Magnesium and Citrate

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6
Q

Calcium Phosphate Stones form in acidic/alkaline urine?

A

Alkaline - as pH increases more phosphates exist in ionic form

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7
Q

Uric Acid Stones form in acidic/alkaline urine?

A

Acidic - solubility of urate increases as pH increases

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8
Q

Diagnosis of Urolithiasis

A

Urinalysis - hematuria, cystine and struvite crystals are diagnostic
Plain Abdominal Film
IVP
Ultrasound
** Spiral CT - no contrast - very sensitive and specific

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9
Q

Most common stone ingredients

A

Calcium oxalate, calcium phosphate.

Ingredients can be: Calcium, oxalate, phosphate, uric acid, cystine, struvite(Urea broken down), triamterene

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10
Q

What inhibits nucleation of kidney stones

A

Magnesium and citrate

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11
Q

What inhibits nuclei or larger structures to adhere to one another

A

Tamm-Horsfall protein in ascending limb of henle

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12
Q

Calcium phosphate stones form in ______ urine; uric acid stones form in _______ urine

A

Alkaline, acidic

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13
Q

Struvite stones process

A

Magnesium ammonium phosphate. Normal urine is under saturated with ammonium phosphate, UTI with urease-producing organism (Klebsiella or proteus)> Alkaline urine forms struvite

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14
Q

Colorless eight sided envelope crystal is

A

Calcium oxalate

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15
Q

Yellow or reddish brown diamond shaped or six sided stone is

A

Uric acid

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16
Q

Cystine crystals are

A

Colorless, hexagon shaped

17
Q

Diagnosis of Kidney stone

A

Urinanalysis, plain abdominal film, IVP, ultrasound, SPIRAL CT

18
Q

Abdominal flatplate: what stones are radiopaque and radiolucent

A

Radiopaque: Calcium oxalate, calcium phosphate, mix
Radiolucent: Uric acid, xanthine, hypoxanthine

19
Q

T/F: If stone is 10mm or more you normally need a urologist to take it out.

A

True

20
Q

How to treat stone passage

A

80-90% pass spontaneously.
Increase fluids.
Strain urine.
Analgesia (NSAID to normal creatinine levels)
Calcium channel blocker/alpha blocker (Nifedipine/tamsulosin- Flomax)

21
Q

When do you put someone in the hospital for kidney stone?

A 
fever
UTI
oral analgesia ineffective
intractable vomiting 
dehydration
22
Q

Urologic management includes:

A

Shock wave lithotripsy (with stint)
percutaneous nephrostolithotomy
ureteroscopy
open stone surgery

23
Q

Risks for kidney stones

A 
sweating
excessive sun exposure
recurrent UTI
neurogenic bladder
gout
chronic diarrhea
family hx (Renal Tubular Acidosis (RTA) and cystinuria)
medications
24
Q

Medications that may cause kidney stones

A 
Carbonic anhydrase inhibitors (eventually drops pH)
triamterene
sulfadiazone
ascorbic acid
Indinavir (HIV med)
Topiramate (Topomax)
Acetazolamide (Diamox)
25
Q

What lab work could you order if someone had a kidney stone

A 
Serum BUN
Serum creatinine,
calcium, PTH if hypercalcemic
phosphorus, 
uric acid, 
Urinalysis (UTI, crystals, pH). Could do a 24 hour urine collection.
26
Q

Preventative therapy for kidney stones

A

Drink more fluids (produce 2 liters of urine, 8 8oz.)
Reduce salt intake
limit animal protein to 8 oz. daily

27
Q

Why would low calcium intake increase urinary oxalate

A

Less calcium is available in intestinal lumen to bind oxalate and prevent its absorption

28
Q

What drinks increase risk of stone

A 
Apple juice, and grapefruit. 
Decrease risk: coffee, tea, beer, wine. 
Colas made no difference. 
Lemonade rich in citrate. 
OJ will increase urine pH and citrate
29
Q

What food will increase urine uric acid

A

Red meat, fish, poultry

30
Q

Foods rich in oxalate

A

Spinach, nuts, PB, strawberries, chocolate, rhubarb, brewed tea

31
Q

What inhibits sodium reabsorption in distal renal tubules?

A

Thiazides (hydrochlorothiazide). Give potassium citrate to replace potassium

32
Q

Medical management of uric acid stones

A

Alkalinize urine to pH 6 to 6.5. pH>7 is risk for calcium phosphate stones. Give potassium citrate. Increase fluids. Dietary restriction of purines. Allopurinol

Adult/Ped Medicine 6 (14 decks)

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