Nephrolithiasis & Chronic Renal Failure Flashcards
What is nephrolithiasis?
Precipitation of a urinary solute as a stone
Risk factors of nephrolithiasis
High concentration of solute in the urinary filtrate
Low urine volume
Clinical presentation of nephrolithiasis
Colicky pain with hematuria
Unilateral flank tenderness
What can chronic renal failure result from?
Glomerular, tubular, inflammatory or vascular insults
Clinical features of chronic renal failure
Uremia - increased nitrogenous waste products in blood (azotemia) result in nausea, anorexia, pericarditis, PLT dysfunction, encephalopathy with asterixis, and deposition of urea crystals in skin
Salt and water retention with resultant HTN
Hyperkalemia with metabolic acidosis
Anemia due to **decreased erythropoietin production by renal peritubular interstitial cells **
Hypocalcemia due to **decreased 1-alpha-hydroxylation of vitamin D by proximal renal tubular cells and hyperphosphatemia **
Renal osteodystrophy due to secondary hyperparathyroidism, osteomalacia, and osteoporosis
Chronic renal fialure Tx
Dialysis or renal transplant
What often develops within shrunken end-stage kidneys during dialysis?
Cysts often develop, increasing the risk for renal cell carcinoma
What is the most common cause of calcium oxalate and/or calcium phosphate nephrolithiasis?
Idiopathic hypercalciuria
Hypercalcemia and its related causes must be excluded
Also seen with Crohn disease
What is the MCC of ammonium magnesium phosphate nephrolithiasis?
Infection with urease-positive organisms; alkaline urine leads to formation of stone
Tx of calcium oxalate and/or calcium phosphate nephrolithiasis?
hydrochlorothiazide
Tx of ammonium magnesium phosphate nephrolithiasis?
surgical removal of stone (due to size) and eradication of pathogen (to prevent reccurence)
What is the MCC of uric acid phosphate nephrolithiasis?
Hot, aird climates
Low urine volume
Acidic pH
Tx of urice acid nephrolithiasis?
Hydration and alkalinization of urine (potassium bicarbonate)
What is the MCC of cysteine nephrolithiasis?
Associated with cysteinuria (genetic defect of tubules that results in decreased reabsorption cysteine)
Tx of cysteine nephrolithiasis?
Hydration and alkalinization of urine
