312 - Nephrolithiasis

Question 1

Which kidney stone do you know?
1\_\_
2\_\_
3\_\_
4\_\_

Answer 1

calcium oxalate (75%)
calcium phosphate (15%)
uric acid (1%)
struvite (<1%)

Question 2

Which disease are considered as predisposing for nephrolithiasis? 5

Answer 2

GI absorption (Crohn's, gastric bypass)
primary hyperparathyroidism
obesity
DM II
distal renal tubular acidosis

Question 3

Which disease are likely to appear in patients with nephrolithiasis? 5

Answer 3

HTN
gout
cholecystitis
decreased bone density
CKD

Question 4

UTI + nephrolithiasis is an __. It should be treated __ to allow urinary __.

Answer 4

emergency
immediately
flow

Question 5

Which nutritional risk factors for nephrolithiasis do you know? 4

Answer 5

animal protein
oxalate
sodium
sucrose/fructose

Question 6

Which protective nutritional factors for nephrolithiasis do you know? 3

Answer 6

calcium
phosphate
phytate

Question 7

What is the most important crystalizing factor giving rise to kidney stones?

Answer 7

citrate

Question 8

Vitamin _ supplements may increase the risk for nephrolithiasis.

Answer 8

C

Question 9

What are the two common presentations of nephrolithiasis?

Answer 9

renal colic

gross hematuria

Question 10

Renal colic pain does not __. It is __, __ without factors which can __ the pain.

Answer 10

disappear
sudden
unilateral
relieve

Question 11

Renal colic pain usually accompanies with __ and may __ to different parts such as__ in men and __ in women.

Answer 11

nausea
radiate
testis
labium

Question 12

What is the treatment for nephrolithiasis + UTI? 2

Answer 12

nephrostomy

stent

Question 13

Diagnosis is based on __, __ examination, and __ test.

Answer 13

history
physical
urin

Question 14

Urine test in nephrolithiasis may show __, __, and __.

Answer 14

RBC
WBC
crystals

Question 15

Confirming nephrolithiasis diagnosis is done with ___without contrast.
Another less sensitive modality is __.

Answer 15

helical CT

US

Question 16

The go to analgesia is __.

Answer 16

NSAID

Question 17

Patients with nephrolithiasis should be kept in __ fluid balance.

Answer 17

euvolemic

Question 18

If pain is sustainable and the patient can drink, treat as __.

Answer 18

outpatient

Question 19

__ blocker may speed up a spontaneous stone passing.

Answer 19

Alpha

Question 20

__ intervention should be withheld if possible. Indications include: 4

Answer 20

Urological
UTI
stone > 6 mm
urological abnormalities
uncontrolled pain

Question 21

Stent may increase the risk for __.

Answer 21

UTI

Question 22

What is the least interventional method to remove kidney stones?

Answer 22

smashing- extracorporeal shockwave lithotripsy

Question 23

For large urinary stones we use __.

Answer 23

nephrostolithotomy

Question 24

> 50% of patients with nephrolithiasis will experience __ in the next __ years.

Answer 24

relapse

10

Question 25

Relapsing nephrolithiasis can be avoided by __.

Answer 25

habitual change

Question 26

Name two oxalate reach food types:

Answer 26

spinach potatoes rhubarb

Question 27

Which signs may help assessing the risk for nephrolithiasis? 4

Answer 27

overweight costovertebral angle sensitivity lower limb edema systemic disease (hyperparathyroidism/gout)

Question 28

What should you look at when examining the serum of a patient with suspected nephrolithiasis? 6

Answer 28

``` electrolytes (hypokalemia, acidosis) Cr calcium uric acid PTH Vitamin D ```

Question 29

What should you look at when examining the urine of a patient with suspected nephrolithiasis? 4

Answer 29

WBC RBC crystals culture (if UTI is suspected)

Question 30

Which urine test is recommended for patients with suspected nephrolithiasis

Answer 30

24 urine collection

Question 31

24 urine collection examination should include: 6

Answer 31

``` total volume electrolytes (Ca/Na/K/P( oxalate citrate uric acid pH ```

Question 32

If possible, analyzing the __ is necessary.

Answer 32

stone

Question 33

Performing ___ CT is the gold standard, but should only be done if it will lead to different __ recommendations.

Answer 33

helical | clinical

Question 34

A good way to decrease the risk for nephrolithiasis is sufficient ___. Urine volume should be > __ liter/day.

Answer 34

hydration | 2

Question 35

Patients with calcium oxalate stones should reduce __ and avoid __ supplement. Using __ will reduce the risk by up to __%.

Answer 35

calcium vitamin C thiazide 50

Question 36

If a patients with calcium oxalate stones is treated with thiazide, remember to restrict __ consumption.

Answer 36

sodium

Question 37

DASH (__) is recommended for patients with calcium oxalate stones.

Answer 37

dietary approached to stop HTN

Question 38

Patients with calcium phosphate stones should avoid __. A good treatment is __.

Answer 38

sodium | thiazide

Question 39

Patients with calcium phosphate stones and low urinary citrate can be treated with __ supplements such as __.

Answer 39

base | potassium citrate

Question 40

Patients with calcium phosphate stones should keep their urine < __ pH. Remember to keep __ consumption low.

Answer 40

6.5 | potassium

Question 41

Patients with uric acid stones should try and increase their urine's __. It can be achieved by increasing __, and reducing __.

Answer 41

pH (6-7) fruits/vegetables (basic) meat (acidic)

Question 42

Patients with uric acid stones can increase their urine pH by supplementing __ or _-_ inhibitors (__/__)

Answer 42

citrate salts Xanthine-oxidase inhibitor febuxostat/ allopurinol

Question 43

Struvite stones are the result of __ caused by urease producing bacteria: 3

Answer 43

UTI Klebsiella pneumoniae proteus Providencia

Question 44

Struvite stones have a typical shape of __. Removal must be done by a __.

Answer 44

staghorn

Question 45

Struvite stones are __ growing, and can fill the entire __.

Answer 45

fast | kidney

Question 46

How can you prevent struvite stones?

Answer 46

preventive treatment for UTI | urease inhibitor acetohydroxamic acid