35. Kidney stones Flashcards Preview

Renal > 35. Kidney stones > Flashcards

Flashcards in 35. Kidney stones Deck (47):
1

Kidney stones can lead to severe complication such as

1. hydronephrosis
2. pyelonephritis
3. SCC

2

Kidney stones- symptoms

1. unilateral flank tenderness
2. colicky pain
3. pain rafiating to groin 44. hematuria ( no casts )

3

Kidney stones - treat and prevent

encourage fluid intake

4

MC kidney stone presentation

calcium ocalate stone in patient with hypercalcemia or normocalcemia
calcium stones MC (80% ) ---> calcium oxalate more common than calcium phosphate

5

kidney stones contain

1. Calcium ( calcium oxalate, calcium phosphate)
2. Ammonium magnesium phosphate
3. Uric acid
4. Cystine

6

kidney calcium stone - types

1. calcium oxalate
2. calcium phosphate

7

calcium oxalate vs calcium phosphate according to precipitation

calcium ocalate --> low pH
calcium phosphate --> high pH

8

calcium oxalate vs calcium phosphate according to x-RAY findings

calcium oxalate --> radiopaque
calcium phosphate --> radiopaque

9

calcium oxalate vs calcium phosphate according to Ct findings

calcium oxalate --> radiopaque
calcium phosphate --> radiopaque

10

calcium oxalate vs calcium phosphate according to urine crystals

calcium oxalate -->like envleope or dumbbel
calcium phosphate -->wedge shaped prism

11

Calcium ocalate stones are precipitated by ( beside low ph)

1. ethylene glycol ( antifreeze) ingestion
2. vitammin C abuse
3. malabsorption ( Crohn disease)
4. hypocitraturia --> low ph

12

kidney calcium stone treatment

calcium oxalate--> thiazides, citrate, low sodium diet
calcium phosphate --> thiazides

13

Ammonium magnesium phosphate stone are precipitated by

high ph

14

Ammonium magnesium phosphate stone on CT or X-ray

radiopaque in both

15

Ammonium magnesium phosphate stone - urine crystal

coffin lid

16

Ammonium magnesium phosphate stone are AKA

sturvite

17

Ammonium magnesium phosphate stone (struvite)- frequency

15% of stones

18

Ammonium magnesium phosphate stone are caused by

infenction with urease + bugs( eg Proteus mirabilis, Staphylococcus saprophyticus, Klebsiella) that hydrolize urea to ammonia --> urine alkalization

19

Ammonium magnesium phosphate stone commonly firm

staghorn calculi

20

staghorn calculi is a

large stone that takes up more than one branch og collecting system in the renal pelvis of the kidney

21

Ammonium magnesium phosphate stones ( struvite) - treatment

1. eradication of underlying infenction
2. surgical removal of stone

22

Urease + organisms

1. proteus
2. cryptococcus
3. Hpylori
4. Ureoplasma
5. Nocardia
6. Klebsiella
7. S. epidermis
8. S. saprophiticus

23

Uric acid stones are precipitates in

low ph

24

Uric acid stones on CT and on X-ray

X-ray --> radiolucent
CT --> minimally visible
BUT visible on US

25

Uric acid stones - urine crystals

rhomboid or rosettes

26

Uric acid stones - frequency

5% of all stone

27

Uric acid stones - visible on

US

28

Uric acid stones - risk factors

1. low urine volume
2. arid climates
3. acidic ph
4 strong association with hyperucicemia

29

Uric acid stones - strong association with

hyperuricemia

30

Uric acid stones often seen in disease with

high turn over ( eg. leukemia)

31

Uric acid stones - treatment

1. urine alkalization
2. allopurinol

32

Cystine stones are precipitated by

low ph

33

Cystine stones on x-ray and CY

x-ray --->radiolucent
CT --> visible

34

Cystine stones -urine crystal

hexagonal

35

CAUSES Cystine stones

Hereditary ( AR) condition in which Cystine - reabsorbing PCT transporter lose function causing cysteinuria ( also poor reabsorption of ornithine, lysine, argirine ) --> cystine is poorly soluble , thus stones form in urine
mnemonic : COLA , Cystine, Ornithine, Lysine , Argirine

36

Cystine stones - age

usually begins in childhood

37

Cystine stones can form

staghorn calculi

38

Cystine stones - diagnosis

+ sodium cyanide nitroprusside test

39

Cystine stones - treatment

1. low sodium diet
2. alkalinization of urine
3. chelating agent if refractory

40

• What are the hallmark symptoms of kidney stones?

Unilateral flank tenderness, colicky pain radiating to groin, and hematuria

41

• What are the four most common renal stones, in descending order of frequency?

Calcium (80%), ammonium magnesium phospate (15%), uric acid (5%), and cystine (1%)

42

• Which kidney stones are radiolucent?

Uric acid and cystine stones (calcium and ammonium magnesium phosphate are radiopaque)

43

• How does pH affect the formation of kidney stones (calcium, ammonium-magnesium-phosphate, uric acid, and cystine)?

Ammonium-magnesium-phosphate precipitates at high pH, uric acid and cystine at low pH—calcium can precipitate at a high or a low pH

44

• An alcoholic confuses antifreeze for beer. What type of kidney stones would be expected to arise as a result?

Calcium oxalate stones caused by ethylene glycol

45

• A patient who abuses vitamin C supplements presents with flank pain and hematuria. What treatments can you offer?

This is a calcium oxalate stone formation due to vitamin C excess, treat with hydration, thiazides, or citrate

46

• A young boy has hematuria and a positive sodium cyanide nitroprusside test result. Why might you want to order more imaging of the kidneys?

He likely has cystine stones, which are poorly soluble and increase the risk of staghorn calculi, which require surgical removal

47

• A patient with gout experiences flank pain and hematuria. X-rays of the abdomen are negative. Do you consider other imaging studies?

Yes, these may be uric acid stones which are invisible on x-ray, yet may be visualized with either CT or ultrasound

Decks in Renal Class (61):