Nephrolithiasis - Nichols/Nace Flashcards
Do pts with kidney shows show urine in the blood all the time?
No, because sometimes, the stone could be obstructing urine flow
What are the clinical symptoms of urinary tract problems?
Pain
Hematuria, gross or microscopic
Dysuria and stangury (frq. small painful voiding)
Are women or men primarily affected by kidney stones?
men 2x, with a recurrence risk of 50% by 5-10 years
What are the common places that one will sense pain from a kidney stone?
Ureteropelvic Juntion
Iliac Vessel Crossing
Bladder Entry
What will urinalysis present with during kidney stones?
hematuria
proteinuria
calcium oxalate crystals
What is the study of choice for kidney stone imaging?
unenhanced helical CT, detects stones as small as 1mm.
rank the types of renal stones from most to least common
calcium oxalate with calcium phosphate calcium phosphate magenisum ammonium phosphate (more common in females) uric acid cystine
What size stone passes spontaneously?
less than 5 mm
Stones greater than what mm are unlikely to pass on their own?
greater than 7 mm
What are invasive ways to treat kidney stones?
extracororeal shock wave lithotripsy
ureteroscopy
percutaneous nephrolithotomy
What are the determinants of solubility and crystallization?
concentration
pH
inhibitors (citrate, urinary glycoproteins)
a nidus (another crystal/intracellular nanobacteria)
What are risk factors for calcium oxalate stones?
hypercalcuria hyperoxaluria pH (alkaline) urinary citrate uric acid
Why are struvite (mag ammon phosphate) more common in women?
UTIs
What is a urease inhibitor that can be used to treat struvite stones?
acetohydroxamic
What are drugs that can lead to stones?
triamterene protease inhibitors (indinavir, atazanavir) guaifensein silicate sulfa drugs
