312 Nephrolithiasis

Question 1

Which drug is most appropriate to manage colicky pain in nephrolithiasis?
A. Ketorolac
B. Tramadol
C. Morphine
D. Hysocine

Answer 1

A. Ketorolac NSAID

Question 2

Most common type of renal stones

Answer 2

Calcium oxalate 75%
Calcium phosphate 15%
Uric acid 8%
Struvite 1%
Cystine less than 1%

Question 3

True or false. Radiographic evidence of a second stone should be considered a recurrence even if the stone as not yet caused symptoms

Answer 3

True.

Question 4

Conditions that predispose to stone formation

Answer 4

GI Malabsorption eg in IBD, gastric bypass surgery
Primary Hyperparathyroidism
Obesity
DM type 2
Distal renal tubular acidosis

Question 5

Point at which concentration product exceed the solubility product

Answer 5

Supersaturation

Question 6

Most clinically important inhibitor of calcium containing stones

Answer 6

Urine citrate

Question 7

Calcium phosphate at the tip of the renal papilla

Answer 7

Randall’s plaque

Question 8

Initiating event in calcium phosphate stone development

Answer 8

Tubular plugs of calcium phosphate

Question 9

Dietary factors that are associated with increased risk of Nephrolithiasis

Answer 9

Animal protein
Oxalate
Sodium
Sucrose
Fructose

Question 10

Dietary factors associated with lower risk of Nephrolithiasis

Answer 10

Calcium
Potassium
Phytate

Question 11

How does calcium intake lead to decreased risk of Nephrolithiasis

Answer 11

Intake of calcium leads to reduction in intestinal absorption of dietary oxalate that results in lower urine oxalate

Question 12

Strong risk factor for calcium oxalate stone formation

Answer 12

Urinary oxalate

Question 13

Supplement associated with increased risk of calcium stone formation especially among men

Answer 13

Vitamin C supplements

Question 14

Urine output of less than what doubles the risk of stone formation

Answer 14

Urine output less than 1L/day

Question 15

Drinks associated with reduced risk of stone formation

Answer 15

Coffee
Tea
Beer
Wine
Orange juice

Question 16

Types of stone based on urine pH
Less than 5.5
More then 6.5
No influenced by urine pH

Answer 16

Less than 5.5: Uric acid
More then 6.5: calcium phosphate
No influenced by urine pH: calcium oxalate

Question 17

Autosomal recessive disorder that causes excessive endogenius oxalate generation by the liver with consequent calcium oxalate stone formation and crystal deposition in organs

Answer 17

Primary hyperoxaluria

Question 18

Autosomal recessive disorder that causes abnormal reabsorption of filtered basic amino acids

Answer 18

Cystinuria

Question 19

Two common presentation for individuals with an acute stone event

Answer 19

Renal colic

Painless gross hematuria

Question 20

Mimicker of renal colic. Where is the stone if pain is like acute cholecystitis

Answer 20

Right ureteral pelvic junction

Question 21

Mimicker of renal colic. Where is the stone if us is like acute appendicitis

Answer 21

Right pelvic brim

Question 22

Mimicker of renal colic. Where is the stone if it is like acute diverticulitis

Answer 22

Left pelvic brim

Question 23

Whre is the stone if patient presents with urine urgency and frequency

Answer 23

Ureterovesical junction

Question 24

Pain reliever to be given to renal colic that is associated with fewer side effect and effective

Answer 24

IV NSAID

Question 25

Drug that when given can increase rate if spontaneous stone passage

Answer 25

Alpha blocker

Question 26

True or false. First time stone formers will have recurrence within 10 years

Answer 26

True.

Question 27

Cornerstone of which therapeutic recommendation in the management of Nephrolithiasis is based

Answer 27

24 hour urine collection

Question 28

Gold standard in the diagnosis of Nephrolithiasis

Answer 28

Helical CT without contrast

Question 29

Urine collection sample before committing patient to long term lifestyle changes

Answer 29

2 urine collection

Question 30

Target urine volume to reduce stone formation

Answer 30

2L/ day

Question 31

Drug that can lower urine calcium excretion

Answer 31

Thiazide

Question 32

Foods with high oxalate contents

Answer 32

Spinach, rhubarb, almonds and potatoes

Question 33

Natural inhibitor of calcium oxalate and calcium phosphate stones

Answer 33

Citrate

Question 34

Type stone more common in patients with distal renal tubular acidosis and primary Hyperparathyroidism

Answer 34

Calcium phosphate

Question 35

Two main risk factor of Uric acid stone formation

Answer 35

Low urine pH | hight Uric acid excretion

Question 36

Predominant influence on urine acid solubility

Answer 36

Urine pH

Question 37

If you have Uric acid stone, what is the target urine pH and how is this achieved?

Answer 37

Target urine pH: 6.5 | Alkalinize urine with NaHCO3 or Potassium citrate

Question 38

What is the target urine pH for Cystine stones and how is this achieved

Answer 38

Target pH: above 7.5 | Alkalinize with Potassium citrate or sodium Bicarbonate

Question 39

Treatment for Cystine stone which covalently bind to cystine

Answer 39

Tiopronin: preferred | Penicillamine

Question 40

Organism that is associated with Struvite stone

Answer 40

Proteus mirabilis K pneumoniae Providencia spp

Question 41

Also known as infection or triple phosphate stone

Answer 41

Struvite stone

Question 42

What is the usual pH in Struvite stone

Answer 42

pH more than 8.0

Question 43

Urease inhibitor drug given to patient with Struvite stone

Answer 43

Acetohydroxamic acid

Question 44

True or false. Increased dietary calcium is predisposed to kidney stone

Answer 44

False. Low calcium

Question 45

Single most strong predictor of nephrolithiasis

Answer 45

Hematuria

Question 46

Pain control on nephrolithiasis

Answer 46

Ketorolac + meperidine/ morphine

Question 47

Size of stone warranting urologic evaluation

Answer 47

Stone more than 10 mm (ESWL or endoscopic) | Urosepsis for emergent decompression (ureteral sent or nephrostomy tube)

Question 48

What to with stone less than 10 mm

Answer 48

Medical management

Question 49

Rate of spontaneous passage is determined by size and location of stone

Answer 49

``` 87% = 1 mm 76%= 2-3 mm ``` 78%= UVJ stone

Question 50

How to facilitate stone passage

Answer 50

Alpha blockers | Less effective for 5 mm size

Question 51

Examples of medical expulsive therapy

Answer 51

Alpha blocker: tamsulosin in 5-10 mm diameter | Ca channel: Nifedipine

Question 52

How to prevent calcium stones

Answer 52

Hydrochlorothiazide | K citrate/ NaHCO3

Question 53

What causes hyperoxaluria

Answer 53

High dose Supplemental vitamin C Post bariatric surgery High oxalate diet

Question 54

How to deal with hyperoxaluria

Answer 54

Ca Carbonate or citrate 1-4 g/dl | Potassium alkali to correct acidosis

Question 55

True or false. Cautious alkali supplementation in calcium phosphate stone

Answer 55

True.