nephrolithiasis Flashcards
1
Q
70% of all stones are..
A
calcium oxalate
2
Q
dehydration is the most common cause of what two stone compositions
A
calcium oxalate
uric acid
3
Q
- forms in wide range pH
- radio-opaque
- not dissolvable
A
calcium oxalate
4
Q
- forms in acidic urine & dissolves w/ urinary alkalinization
- radiolucent
A
uric acid stones
5
Q
- etio: metabolic conditions
- forms in alkaline urine
- radio-opaque
A
calcium phosphate
6
Q
- etio: UTI
- forms in alkaline urine
- radio-opaque
- dissolves w/ urinary acidification
A
magnesium ammonium phosphate
7
Q
- etio: cystinuria (hereditary); forms starting in childhood
- forms in acidic urine; radio-opaque
- disolves with alkalinization
A
cysteine stones
8
Q
- colic/wave like, sharp flank pain (may radiate to abdomen, testicles/labia)
- hematuria; N/V; LUTS or asymp. (usually non-obstructing)
A
nephrolithiasis (kidney stones)
obstructing ones usually cause sx secondary to hydronephrosis
intermittent obstruction–> colic
9
Q
- fluid in kidneys d/t obstruction anywhere along tract
- silent or sx
- can d/t stone, strictures, BOO, BPH, extraureteral compression, trauma, edema, UPJ, clot, reflux
A
hydronephrosis
hydroureteronephrosis?
imaging: IVP (IV pyelogram), KUB, non- con CT flank, etc
10
Q
tx of nephrolithiasis
A
- sx control
- surveillance- small nonobstructing renal calculi
- dissolution tx- uric acid stone -> urinary alkalinization
- medical expulsive therapy
- surgical intervention– large ureteral or bladder calculi, refractory small/medium, large non-obstructing
11
Q
what is medical expulsive therapy
A
- trial of spontanoeous passage where you try hydration, pain control + alpha blocker or steroids
- good if its a passable stones, good pain control, no infection, appropriate renal function
12
Q
what surgical procedure is this
- gel pad under lower body & fluoroscopy
- US waves to break up stone +/- stenting
- C/I: pregnancy, coagulopathy, UTI, renal artery calcifications, AAA, radiolucent stones
- complications: hematoma, ecchymosis, UTI, pain, steinstrasse, lower stone clearance rate
A
ESWL– extracorporal shockwave lithotripsy
13
Q
- option for stone basketing; good for failed ESWL or non-ESWL candidate
- cystolitholapaxy
- complications: ureteral perforation, stricture
- rigid version for ureteral distal stones
- felxible for failed ESWL, < 2 cm, complex anatomy, proximal stones
A
ureteroscopy w/ laser lithotripsy
14
Q
- removes renal calculi from kidney through percutaneous access from back into kidney
- small hole for large stones
- disadv: 2-3 day admission, stent or nephrostomy tube
- uses: large stones over 2.5 cm, failed ESWL, complex anatomy, staghorn stones
- complications: infxn, pneumo/hemothorax, injury, extravastation of urine, bowel injury
A
PCNL– percutaneous nephrolithotomy
15
Q
5 indications for emergent tx
A
- obstructing stone + infection
- bilateral
- one kidney
- refractory pain
- cannot tolerate oral intake d/t N/V
goal is to drain system via stent & run or nephrostomy tube
