Renal Lithiasis

Question 1

Who is more prone?

Answer 1

males > females

whites>hispanics>blacks

Question 2

why does the incidence of kidney stones seem to be increasing?

Answer 2

becuase of rise in metabolic syndrome in us population

Question 3

what population has shown the highest increase in kidney stones?

Answer 3

children, particularly black female (teens)

Question 4

what is a typical pt for a kidney stone?

Answer 4

white male in his 30s to 40s

Question 5

what kind of stone accounts for 80% of stones, usually paired w/ oxalate, radio-opaque?

Answer 5

calcium stones

Question 6

these stones account for <10% of stones

Answer 6

uric acid

Question 7

these stones are
comprised of mg ammonium phosphate,

account for <15% of stones in us & 30% worldwide,

more common in women, & associated with infex?

Answer 7

struvite aka staghorn

Question 8

these stones account for 1% of stones in adults, 8% in kids

& are genetically determined?

Answer 8

cystine, also staghorn or multiple stones

Question 9

these stones are extremely rare & are result of genetic disorder

Answer 9

xanthine

Question 10

what kind of pain does pt present with?

Answer 10

flank, back, abdomen, scrotum/labia & it is sudden/severe w/ urgency/frequency to urinate

Question 11

What are other constitutional symptoms?

Answer 11

nausea, vomiting

fever may/may not be present

Question 12

how does hematuria present?

Answer 12

gross or microscopic

Question 13

how is bp & pulse?

Answer 13

elevated & increased

Question 14

is cva present?

Answer 14

yes, tender

Question 15

facilitation happens at what spinal level?

Answer 15

T10-L1

Question 16

what other illnesses in the kidney mimic renal lithiasis?

Answer 16

pyelonephritis, nephritis, renal abscess, renal infarction, renal vein thrombosis, renal tumor, hydronephrosis due to obstruction, iatrogenic (nephrostomy tube), blood clot, sickle cell in renal pelvis

Question 17

What other illnesses not in the kidney mimic renal lithiasis?

Answer 17

muscle spasm (psoas & quadratus lumborum), aortic aneurysm, rib dysfunction, fractures, lower lobe pneumonia, pleuritic, appendicitis, abdominal/pelvic tumor, endometriosis, tubal pregnancy, prostatic hypertrophy, iatrogenic (clips), herpes zoster

Question 18

calcium supplementation

Answer 18

yes, can increase calciuria

Question 19

decreased water intake

Answer 19

yes, leads to supersaturation of urine

Question 20

increased soda consumption

Answer 20

yes, increase na & sucrose load

Question 21

high protein diet

Answer 21

yes, increases uric acid & ca excretion & decreased citrate excretion

Question 22

high sodium diet

Answer 22

yes, increases calcium excretion

Question 23

fructose, sucrose, xylitol

Answer 23

yes, increases ca excretion

Question 24

aspartame

Answer 24

no

Question 25

eating lots of spinach, peanut butter, vitamin c supplementation

Answer 25

yes, increases oxalate excretion

Question 26

eating lots of citrus fruits

Answer 26

no, increases citrate excretion which makes calcium more soluble

Question 27

gout

Answer 27

yes, associated with high uric acid levels

Question 28

htn

Answer 28

we don't know, these 2 commonly occur together however

Question 29

diabetes milletus & metabolic syndrome

Answer 29

yes, associated w/ high uric acid levels

Question 30

immobility

Answer 30

yes, associated with high calcium levels

Question 31

medullary sponge kidney, renal tubular acidosis, & kidney failure

Answer 31

yes, associated with high calciuria & low urinary citrate

Question 32

hypothyroidism

Answer 32

yes. decreased gfr --> increase in vasopressin --> decrease in urine production --> supersaturated urine

Question 33

hyperparathyroidism & elevated vitamin d

Answer 33

yes. hypercalcemia --> hypercalciuria

Question 34

seizure disorder

Answer 34

no

Question 35

uti

Answer 35

yes, lowers urinary citrate and causes struvite stones

Question 36

gastric bypass surgery

Answer 36

yes. short gut syndrome. increase oxalate uptake & excretion

Question 37

chronic diarrhea

Answer 37

increase oxalate uptake & excretion, lowers urinary citrate

Question 38

fasting & binge drinking

Answer 38

associated w/ high uric acid levels

Question 39

cancer

Answer 39

no, but drugs used to tx lymphoma, leukemia, multiple myeloma can cause stones

Question 40

furosemide, acetazolamide, mg antacids, glucocorticoids, theophyline

Answer 40

increase calcium oxalate stones

Question 41

Aspirin, hydrochlorthiazide, probenecid

Answer 41

uric acid stones

Question 42

topiramate

Answer 42

no; increases urinary pH & decreases urinary citrate

Question 43

testosterone

Answer 43

no increases urinary oxalate excretion

Question 44

laxatives

Answer 44

no. promote supersaturation of ammonium & urates

Question 45

ephedrine, tmp/smx (trimethoprim/sulphamethoxazole), ciproflaxin, triamterene, acyclovir, indinavir

Answer 45

no, drug crystallizes out of urine

Question 46

what are other additional risk factors to renal lithiasis?

Answer 46

obesity, weight gain, living in warmer climate, family hx/genetics, tea/soda consumption, antibiotic use/altered microbiome, glysphosphate exposure (roundup)

Question 47

what kind of immediate lab studies are done when suspecting a kidney stone?

Answer 47

u/a w/ microscopy, u/a culture & sensitivity (C&S), Na, K, Cl, CO2, calcium, creatinine/bun, uric acid, random blood sugar level, cbc

Question 48

what lab studies should you order later?

Answer 48

stone analysis ,tsh, pth, vitamin D level, 24 hour urinalysis

Question 49

look at slide for pictures of crystals

Answer 49

these are calcium oxalate stone calcium oxalate dihydrate crystals are bipyramidally shaped hexagonal cystine crystals are hexagonally shaped

Question 50

What is the gold standard radiological studies that should be done?

Answer 50

helical ct w/o contrast (not good for children, teens or pts with frequent stones due to radiation exposure) It is done without contrast because contrast obscures stones & if the kidney is already injured, contrast will ruin ir further)

Question 51

what is the second line of radiological studies?

Answer 51

kub x ray

Question 52

what is the third line of radiological studies

Answer 52

u/s of abdomen (good for kids & determines if other organs affected)

Question 53

how should you treat a stone that is bigger than 6 mm & less than 10 in the renal pelvis or staghorn?

Answer 53

percutaneous nephrostomy/nephrolithotomy or extracorporeal shockwave lithotripsy

Question 54

how do you tx a stone that is in the ureter & not passing?

Answer 54

endoscopic cystoscopy to retrieve stone

Question 55

how do you tx a young child with a stone

Answer 55

postural therapy w/ hydration, percussion in trendelenburg position

Question 56

how do you tx a kidney that is barely functioning?

Answer 56

nephrectomy

Question 57

how do you tx if ther are remaining fragments from struvite calculi

Answer 57

oral chemolysis w/ acetohydroxamic acid & suppressive antibiotic tx