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6- Renal Medicine > Calculus Dx > Flashcards

Calculus Dx Flashcards

(42 cards)

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1
Q

Risks factors of calculus

A

Increased weight and body mass index
Increased socioeconomic status
Obesity in women
Metabolic syndrome (acid calculi due to low urinary pH)

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2
Q

2 phenomenon important for crystal formation in urine

A

Supersaturation of urine with stones

Presence of urinary inhibitors - nephrocalcin, uropontin, citrate, magnesium , tamm-horsfall

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3
Q

What is the noncrystalline component of stones made of

A

Mucoprotein s
Proteins
Carbohydrates
Urinary inhibitors

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4
Q

Most important determinant of acid stone formation

A

Low urinary pH

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5
Q

Stones formed in low pH

A

Calcium oxalate stones
Uric acid stones

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6
Q

Type of urine in infection stones

A

Alkaline urine

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7
Q

Type of bacteria in infection stone

A

Urease producing bacteria

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8
Q

Name of stones formed in infection stones

A

Triple phosphate stones

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9
Q

What happens when urine is above Ksp (solubility product )

A

Normally no formation of crystals due to inhibitors of crystal formation

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10
Q

What happens when urine concentration of calcium and oxalate is very high above Kf ( formation product)

A

Inhibitors become ineffective and crystals form

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11
Q

When do you say that urine is metastable

A

When urine is between solubility product and formation product

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12
Q

Steps of crystal formation

A

Nucleation - crystal formation on epithelial , foreign bodies, other crystals surfaces

Aggregation - crystal nuclei form into clumps

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13
Q

Location of calcium absorption

A

Small intestine

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14
Q

Hormone responsible for conversion of 25-dihydroxyvitamin D3 to 1,25(OH)2D3

A

Parathyroid hormone

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15
Q

Hormone responsible for proximal tubular reabsorption of calcium and renal phosphate excretion n

A

PTH

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16
Q

Factors influencing intestinal oxalate absorption

A

Luminal calcium
Magnesium
Oxalate degrading bacteria

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17
Q

Biochemistry of absorptive hypercalciuria

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A

Normal serum calcium
Normal or suppressed PTH
Normal fasting urinary calcium
Elevated urinary calcium

18
Q

Biochemistry of renal hypercalciuria

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A

Impaired renal calcium reabsorption
PTH hypersecretion
Increased fasting hypercalciuria

19
Q

Dx causing resorptive hypercalciuria

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A

Primary hyperparathyroidism

20
Q

Indications for metabolic stone evaluation

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A

Recurrent stone formers
Strong family hx
Intestinal dx specially if chronic diarrhea
Pathologic skeletal fractures
Osteoporosis
Hx Urinary trat infection with calculi
Hx of gout
Infirm health
Solitary kidney
Anatomical abnormalities
Renal insuffiency

21
Q

Hx taking in stones

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A

Predisposing conditions
Medications (calcium, vitamin C, vitamin D, acetazolamide , steroids)
Diet excess
inadequate fluid intake
Excessive fluid loss

22
Q

Metabolic Investigations

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A

Metabolic panel - sodium, potassium, chloride, carbon dioxide , blood urea nitrogen , creatinine
Calcium
Parathyroid hormone
Uric acid levels

23
Q

Urine investigations

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A

Urinalysis - pH<7.5 (infection lithiasis) , pH<5.5 ( uric acid lithiasis)
Sediment for crystalluria
Urine culture
Urea splitting organisms for infection
Qualitative cystine

24
Q

Radiography findings

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A

Radioopaque stones in calcium oxalate , calcium phosphate , magnesium, ammonium phosphate , cystine

Radioluscent stones in urine acid, xanthine, triamterene

Stone analysis

25
Conservative medical management
Drink - 3000ml / day to maintain urine output abode 2500ml/day Medical expulsion therapy when stone <5mm Low animal protein intake High fruits and vegetables diet Restriction of dietary sodium CHO restriction Calcium supplement Decrease oxalate diet Avoid large doses of vitamin c
26
Medications used in medical expulsion therapy
Tamsulosin NSAIDs Phytothérapie Potassium citrate
27
Does dietary calcium restriction decrease stone formation
No actually increase it
28
How can dietary calcium help decrease stone
By binding intestinal oxalate and decrease its absorption
29
Medications that form stone
Inidnavir Ephedrine Triamterene Magnesium trisilicate antacids Sulfamethoxazole-trimethoprim
30
Medications that provoke stone formation
Carbonic anhydrase inhibitors Topirimate Furosemide Vitamin c excess Vitamin d excess Laxatives
31
Surgical management of stones in kidney
Endoscopy with percutaneous nephrolithotomy or uteroscopy+laser fragmentation Laparoscopic nephrolithotomy Open surgery Extracorporeal shockwave lithotripsy
32
Surgical management of stones in bladder
Endoscopic cystolitholapaxy/ Open cystolithotomy
33
Surgical management of stones in ureters
Uteroscopy+laser, ballistic or ultrasonic lithotripsy Open ureterolithotomy PCNL
34
Surgical management of stones in urethra
Endoscopic extraction Open urethrolithotomy
35
Age group with highest incidence of renal stone in developed countries
Young men
36
Predisposing factors for kidney stones
Low urine volumes: high ambient temperatures, low fluid intake Diet: high protein, high sodium, low calcium High sodium excretion High oxalate excretion High urate excretion Low citrate excretion Hypercalcaemia Ileal disease or resection (increases oxalate absorption and urinary excretion) Renal tubular acidosis type I Familial hypercalciuria Medullary sponge kidney Cystinuria Renal tubular acidosis type I (distal) • Primary hyperoxaluria
37
People at risk of bladder stone in developing countries
Children
38
Are renal or bladder stone more common in the developed countries b
Renal stone
39
Clinical features
Asymptomatic Pain Hematuria Acute loin pain radiating to anterior abdomen + hematuria + restlessness ->renal or ureteric colic Pallor Sweating Vomiting
40
What disease is indicated by ureteric colic
Obstruction of ureter by calculus or tumor or renal papilla
41
Investigations
Plain abdominal x ray for calcium stone Non contrast CTKUB gold standard US in unstable patient, young women with undersirable exposition. To radiation Blood test - calcium, phosphate, uric acid , urea and electrolytes , bicarbonate , parathyroid Urine - dipstick for proteins, blood, glucose, amino acids 24h urine Stone for composition
42
Treatment
Immédiat -> analgesics , antiemetics ATBS if surgery Uteroscopy and stone fragmentation extracorporeal shock wave lithotripsy Nephrtomy or stent

6- Renal Medicine (8 decks)

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