Flashcards in Kidney Stones First-Aid Deck (29):
Where to kidney stones usually form?
In the kidney, duh. But mostly in the major and minor calyces
How are kidney stones generally treated?
Therapies for stone prevention more desirable than treatment. Usually encouraging fluid intake.
Why do stones form?
etiology of stone formation remains unclear, but we do know some predisposing factors
What are general risk factors for kidney stones?
increased concentration of solute in urine and low urine volume
What is the general clinical pictures for kidney stones?
unilateral flank tenderness, colicky pain radiating to groin, and hematuria
What general structure will you see in kidney stones under the microscope?
layering of solute crystals
What are some Drugs That Can Form Stones?
What are some Drugs That Cause Stones?
• Vitamin D
• Calcium supplements
• Loop diuretics
• Ethylene glycol
How prevalent are cystine stones?
cause 1% of stones may have genetic defect in 2 possible genes one is recessive (typeA) and one is incompletely dominant (typeB)
What shape are cystine stones?
hexagonal and radiopaque
Who gets cystine stones?
mostly children secondary to cystinuria and can form staghorn calculi
What test is positive with cystine stones?
sodium nitroprusside test
How do we treat cystine stones?
alkalinization of urine and hydration
What can cause primary hyperoxalosis?
Rare genetic disorders of liver enzymes leading to excessive endogenous oxalate synthesis with 3 known gene defects all autosomal recessive only way to completely treat is liver transplant
What are diet risk factors for stones?
Diet Risk Factors:
– Low fluid intake
– High salt intake
– High protein intake (especially meat)
– Low calcium intake
– High oxalate intake (spinach, beets, rhubarb,
nuts, beans, chocolate, soy products, tea?)
What is the most common type of stone?
calcium forms 80% of stones
What do calcium stones look like?
envelope or dumbbell shaped radiopaque
What do calcium stones have in them besides Ca?
oxalate or phosphate or both
What promotes formation of calcium stones?
hypercalciuria can be idiopathic or secondary to hypercalcemia d/t cancer or increased PTH
Ethylene glycol, vitamin c abuse and Crohn's disease can predispose you to what kind of stone?
How do you treat calcium stones?
thiazides (Ca sparing diuretic) and citrate
What are some acute treatments for kidney stones?
Noninvasive: pain control, fluids, dissolution therpay
Extra-corporeal shock wave lithotripsy (ESWL)
Ureteroscopy: Stone basketing & Lithotripsy (laser, electrohydraulic)
Percutaneous approach (not used much anymore)
Post-obstructive infection medical/surgical emergency
Generally, how do you diagnose kidney stones?
– CT Scan
How prevalent are uric acid stones and what are some risk factors?
decreased urine volume, arid climates, gout, diseases with increased cell turnover (leukemia) and acidic pH
What shape are uric acid stones?
rhomboid or rosettes that are radiolucent
How do we treat uric acid stones?
• Low protein/high fruit diet
• Alkalinize urine
• Xanthine oxidase inhibitors– Allopurinol & Febuxostat
What are ammonium magnesium phosphate stones AKA and how often do they happen?
struvite which is caused by infection with urease + bugs and cause about 15% of stones
How do we treat struvite stones?
• Sterilize urine – eliminate urea splitting bacteria
• Remove residual stone material (surgical)
• Adjunctive therapies: Urease inhibitors – acetohydroxamic acid & Chemolysis – hemiacidrin