Kidney Stones Flashcards Preview

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Flashcards in Kidney Stones Deck (30):
1

What are three forms of Urinary Tract Crystallization?

  • Nephrolithiasis/Urolithiasis - stone forming disorders/drugs
  • Nephrocalcinosis - medullary sponge kidney
  • Bladder Stones - bladder dysfunction

2

Medullary sponge kidney is associated with malformation of the _____ tubules

distal

3

What are some key factors associated with the etiology of stone formation?

  • Urinary supersaturation
  • Crystal retention at the renal papilla
  • Associated risk factors

4

What are the most common compositions of kidney stones?

Which requires a predisposing factor to form?

Mostly calcium oxalate

30% have calcium phosphate

Urates are third most common

Struvite next most common - Requires urea secreting bacteria to form

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5

WHat are some demographic associations with kidney stones?

  • Men> women (about 2:1 although has decreased recently)
  • White race more commonly affected
  • Peak incidence in middle age
  • Substantial regional variations

6

Lifetime prevalence of kidney stones = __-__%

Recurrence rates exceed __% in 5 years

5-15%

50%

7

Is the prevalence of kidney stones increasing or decreasing?

Increasing

8

What drugs can form stones?

Indinavir

Acyclovir

Triamterene

Sulfamethoxazole

9

What are some genetic diseases causing stones?

Cystinuria - L-cystine

Primary hyperoxalosis - calcium oxalate

Dent Disease - calcium oxalate or calcium phsophate

10

Describe L-Cystine stone disease

Transporter system for recovering L-Cystine is defective - build up forms heagonal plates

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11

What are the three types and two possible defective genes associated with L-Cystine stone disease and what is their prevalence?

  • Type A (38%) - SLC 3A1 - Recessive, targeting protein 
    • Proximal tubule - high affinity and low capacity
  • Type B (47%) - SLC7A9 - incompletely dominant, transporter
    • Proximal tubule - Low affinity and high capacity
  • Type AB (14%)

12

Primary hyperoxalosis/hyperoxaluria is a rare genetic disorder which leads to excessive synthesis of ______ ______

endogenous oxalate

13

What are the 3 known gene defects associated with primary hyperoxalosis and what do they cause?

  • PH1 - 80% - alanine-glyoxylate aminotransferase (AGXT) defect
  • PH2 - 10% - glycoxylate reductase/hydroxy pyruvate reductase (GRHPR) defect
  • PH3 - 10% - 4-hydroxy-2-oxaloglutarate aldolase (HOGA1) defect

14

Why can calcium oxalate easily cause supersaturation in kidney?

Solubility of calcium oxalate in water is very low

15

As urine volume increases, relative supersaturation for calcium oxalate _______

decreases

16

What are some diet risk factors associated with hyperoxaluria?

  • Low fluid intake
  • High salt intake
  • High protein intake
  • Low calcium intake
  • High oxalate intake

17

Increasing calcium in the diet ______ risk of Kkidney stones

decreases

18

How do kidney stones present on physical exam?

  • Distress
  • Fever
  • Hematuria
  • Elevated WBCs
  • Elevated serum creatinine
  • Nausea, vomiting

19

What are the two best diagnostic tools for kidney stones?

CT scan (best)

Ultrasound

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20

What can inhibit all stone types?

What inhibits calcium stones specifically?

Citrate inhibits all

Magnesium inhibits calcium stones

21

What is the most common urinary abnormality in calcium oxalate stone formers?

Low urine volume

22

How are kidney stones treated?

Removal of stone

Symptom control

23

What are acute treatments to stone formation?

  • Noninvasive
    • pain control and fluids
    • Medical expulsive therapy
    • Dissolution therapy
  • Extra-corporeal shock wave lithotripsy (ESWL)
  • Uretoscopy
  • Percutaneous approach
  • Surgery

24

What are some chronic treatments to stone formation?

  • Dilution
  • Alkalinize urine
  • Cystine binding drugs (disulfide exchange)

25

How do you treat uric acid crystals?

  • Dilution
  • low protein diet
  • alkalinize urine
  • Xanthine oxidase inhibitors
    • Allopurinol
    • Febuxostat

26

How do you treat struvite crystals?

  • Dilution
  • Sterilize urine (eliminate bacteria)
  • Remove residual stone material (surgical)
  • Adjunctive therapies

27

How do you treat calcium stones?

  • Dilution
  • Maintain normal calcium intake
  • Reduce urine calcium exretions
  • Reduce urine oxalate
  • Increase urine citrate

28

High water intake _____ stone recurrence rates

decreases

29

High protein intake _____ calcium excretion in the urine

increases

30

Increased duration of treatment with thiazide diuretics corresponds to ______ stone recurrence compared to placebo

decreased