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Nephrology - HARRISONS > Nephrolithiaisis > Flashcards

Nephrolithiaisis Flashcards

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1
Q

What is nephrolithiasis?

A

Nephrolithiasis, or kidney stone disease, is a common, painful, and costly condition.

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2
Q

What percentage of kidney stones are calcium oxalate stones?

A

Approximately 75% of kidney stones are calcium oxalate stones.

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3
Q

List the types of kidney stones in order of their commonality.

A
  • Calcium oxalate (∼75%)
  • Calcium phosphate (∼15%)
  • Uric acid (∼8%)
  • Struvite (∼1%)
  • Cystine (<1%)
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4
Q

True or False: Nephrolithiasis is often fatal.

A

False.

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5
Q

What is the peak annual incidence of nephrolithiasis among white men at age 40?

A

Approximately 3.5 cases per 1000.

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6
Q

What medical conditions are associated with nephrolithiasis?

A
  • Gastrointestinal malabsorption
  • Primary hyperparathyroidism
  • Obesity
  • Type 2 diabetes mellitus
  • Distal renal tubular acidosis
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7
Q

What is the role of urine citrate in kidney stone formation?

A

Urine citrate is a natural inhibitor of calcium-containing stones; lower urine citrate increases the risk of stone formation.

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8
Q

Fill in the blank: Nephrolithiasis can lead to end-stage _______ if not appropriately treated.

A

renal disease.

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9
Q

What dietary factors are associated with an increased risk of nephrolithiasis?

A
  • Animal protein
  • Oxalate
  • Sodium
  • Sucrose
  • Fructose
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10
Q

What is the effect of higher dietary calcium intake on kidney stone formation?

A

Higher dietary calcium intake is related to a lower risk of stone formation.

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11
Q

How does fluid intake affect urine volume and kidney stone risk?

A

Lower urine volume increases the risk of stone formation; higher fluid intake increases urine volume.

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12
Q

What is the relationship between urinary oxalate and calcium oxalate stone formation?

A

Higher urinary oxalate excretion increases the likelihood of calcium oxalate stone formation.

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13
Q

What is the significance of urine pH in kidney stone formation?

A

Urine pH influences the solubility of some crystal types; uric acid stones form at pH ≤5.5 and calcium phosphate stones at pH ≥6.5.

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14
Q

What is the genetic risk factor for nephrolithiasis?

A

Having a family history of stone disease increases the risk of nephrolithiasis more than twofold.

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15
Q

What are the two most common rare monogenic disorders that lead to stone formation?

A
  • Primary hyperoxaluria
  • Cystinuria
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16
Q

True or False: Nephrolithiasis can be associated with upper urinary tract infections.

A

True.

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17
Q

What are the two common presentations for individuals with an acute stone event?

A
  • Renal colic
  • Painless gross hematuria
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18
Q

What is the main determinant of urine volume?

A

Fluid intake.

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19
Q

What is the relationship between dietary oxalate and urinary oxalate?

A

Dietary oxalate is the major contributor to urinary oxalate, and higher dietary calcium intake reduces gastrointestinal oxalate absorption.

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20
Q

What factors contribute to higher urine calcium excretion?

A
  • Greater gastrointestinal calcium absorption
  • Greater bone turnover
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21
Q

What is the main dietary factor that lowers the risk of stone formation?

A

Higher potassium intake.

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22
Q

What is the consequence of low calcium intake for stone formers?

A

It increases the risk of stone formation and may contribute to lower bone density.

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23
Q

How does age influence the incidence of nephrolithiasis?

A

The incidence is highest in middle-aged individuals but can occur in infants and the elderly.

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24
Q

What is the initial symptom of acute renal colic?

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A

Sudden onset of unilateral flank pain

This pain can increase rapidly and is often accompanied by nausea and vomiting.

25
How can the location of a ureteral stone affect pain radiation?
Pain may radiate: * Anteriorly if lodged in the upper ureter * To the ipsilateral testicle in men or ipsilateral labium in women if lodged in the lower ureter ## Footnote Pain location can indicate the position of the stone.
26
What can gross hematuria without pain indicate?
It may indicate the presence of a ureteral stone ## Footnote Hematuria can occur even in the absence of pain.
27
What other diagnoses can be confused with acute renal colic?
Conditions that may mimic acute renal colic include: * Acute cholecystitis * Acute appendicitis * Acute diverticulitis * Bacterial cystitis * Acute pyelonephritis ## Footnote Misdiagnosis may occur based on the stone's location.
28
What is the preferred imaging study for diagnosing ureteral stones?
Helical computed tomography (CT) ## Footnote It is highly sensitive and can visualize uric acid stones.
29
What are common findings in urine sediment of a patient with renal stones?
Red and white blood cells and occasionally crystals ## Footnote These findings can help in the diagnosis of stone type.
30
What is the role of parenteral nonsteroidal anti-inflammatory drugs in acute renal colic?
They are as effective as opioids in relieving symptoms with fewer side effects ## Footnote Ketorolac is an example of such a drug.
31
When should urologic intervention be considered in a patient with renal stones?
If there is evidence of UTI, low probability of spontaneous stone passage, or intractable pain ## Footnote Factors like stone size and location may influence this decision.
32
What is the least invasive treatment option for ureteral stones?
Extracorporeal shockwave lithotripsy (ESWL) ## Footnote Its usage has declined in favor of endourologic approaches.
33
What factors should be evaluated to prevent recurrence of kidney stones?
Predisposing factors such as: * Dietary habits * Fluid intake * Medical history * Family history ## Footnote Evaluating these factors can help in modifying risks.
34
What dietary factors are important in stone disease?
Calcium intake, high-oxalate foods, and fluid intake ## Footnote These factors should be assessed in dietary history.
35
What should be included in a physical examination for stone disease?
Weight, blood pressure, costovertebral angle tenderness, lower-extremity edema ## Footnote Signs of systemic conditions should also be assessed.
36
What laboratory evaluations are important for stone disease?
Serum levels of: * Electrolytes * Creatinine * Calcium * Uric acid ## Footnote PTH levels may also be measured if indicated.
37
What is the significance of 24-hour urine collections in stone evaluation?
They provide crucial data for therapeutic recommendations ## Footnote Factors like total volume and levels of calcium, oxalate, and uric acid should be measured.
38
What is the gold standard diagnostic test for kidney stones?
Helical CT without contrast ## Footnote It provides detailed imaging for stone burden assessment.
39
What is the recommended urine volume to reduce stone formation risk?
At least 2 L/day ## Footnote Individual fluid needs may vary based on insensible losses.
40
What are the risk factors for calcium oxalate stones?
Higher urine calcium, higher urine oxalate, lower urine citrate ## Footnote These factors contribute to the formation of calcium oxalate stones.
41
What dietary approach can help prevent calcium oxalate stones?
Maintain adequate calcium intake and avoid excessive sodium ## Footnote A diet with 1200 mg of calcium can reduce stone formation.
42
What is the role of thiazide diuretics in managing calcium oxalate stones?
They can significantly lower urine calcium excretion ## Footnote Thiazides can reduce recurrence by approximately 50%.
43
How can dietary oxalate absorption be reduced?
By avoiding high-oxalate foods and ensuring adequate calcium intake ## Footnote Foods to avoid include spinach, rhubarb, and potatoes.
44
What is the DASH diet's relevance to kidney stone prevention?
It has shown a strong inverse association with the risk of stone formation ## Footnote The DASH diet is beneficial for overall health and may help reduce blood pressure.
45
What dietary pattern is recommended for managing blood pressure and reducing stone formation risk?
DASH (Dietary Approaches to Stop Hypertension) diet ## Footnote The DASH diet is shown to reduce blood pressure and has a strong inverse association with the risk of stone formation.
46
What are the main risk factors for calcium phosphate stone formation?
* Higher urine calcium concentration * Lower urine citrate concentration * Higher urine phosphate levels * Higher urine pH (≥6.5) ## Footnote Calcium phosphate stones are more common in patients with distal renal tubular acidosis and primary hyperparathyroidism.
47
What is the recommended intervention for reducing urine calcium in calcium phosphate stone formers?
Thiazide diuretics with sodium restriction ## Footnote These interventions are based on modifying recognized risk factors as there are no randomized trials for preventive recommendations.
48
What dietary modifications can help prevent uric acid stone formation?
* Increasing intake of alkali-rich foods (e.g., fruits and vegetables) * Reducing intake of acid-producing foods (e.g., animal flesh) ## Footnote Alkalinizing the urine is crucial for preventing uric acid stone formation.
49
What is the goal urine pH for preventing uric acid stones?
6.5 ## Footnote This pH level can be achieved through dietary changes or supplementation with bicarbonate or citrate salts.
50
What medication can be used to reduce urine uric acid excretion if dietary modifications are insufficient?
Xanthine oxidase inhibitors (e.g., allopurinol or febuxostat) ## Footnote These can reduce urine uric acid excretion by 40-50%.
51
What is the primary focus for cystine stone prevention?
Increasing cystine solubility ## Footnote This can be achieved through medication that binds cystine and raises urine pH.
52
What is the preferred alkalinizing agent for cystine stone prevention?
Potassium citrate or bicarbonate ## Footnote Sodium salts may increase cystine excretion, so they are not preferred.
53
What are struvite stones and how do they form?
Struvite stones, also known as infection stones, form when the upper urinary tract is infected with urease-producing bacteria ## Footnote These bacteria elevate urine pH to supraphysiologic levels (>8.0).
54
What is required for the management of struvite stones?
Complete removal by a urologist ## Footnote Preventing UTIs is essential to avoid new stone formation.
55
What is the importance of long-term follow-up for patients with a history of kidney stones?
To ensure the preventive regimen is implemented and reduces the risk of new stone formation ## Footnote This includes repeat 24-hour urine collections typically annually.
56
What imaging technique is often used for follow-up in patients with recurrent renal colic?
CT scans ## Footnote While CT provides the best information, it has a higher radiation dose compared to plain abdominal radiography.
57
True or False: The preventive regimens for kidney stones cure the underlying pathophysiologic process.
False ## Footnote Recommendations typically need to be followed for the patient’s lifetime.
58
Fill in the blank: In patients with recurrent upper UTIs, the urease inhibitor _______ can be considered.
acetohydroxamic acid ## Footnote This agent should be used with caution due to potential side effects.

Nephrology - HARRISONS (2 decks)

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