Renolithiasis Flashcards Preview

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Flashcards in Renolithiasis Deck (58):
1

When there is increased calcium present within the kidney it can either lead to?

nephrocalcinosis or nephrolithiasis

2

generalized calcification which can result from either of the two fundamental types of pathologic calcification: metastatic or dystrophic

Nephrocalcinosis

3

Nephrocalcinosis can involve either the (1) or the (2)

1. tubules 2. interstitial area between tubular cells

4

Nephrocalcinosis leads to the destruction of the tubular system, resulting in reduced (1), (2) (loss of sodium), or (3) (loss of bicarb or retention of acid as H+).

1. renal concentrating ability 2. salt wasting 3. renal tubular acidosis

5

Metastatic calcification usually present when there is (1), caused by such disorders as (2), or (3) which increase calcium; or disorders that increase intestinal calcium absorption, like (4)

1. elevated serum calcium 2. primary hyperparathyroidism 3. osteolytic cancer metastasis 4. vitamin D overdose or sarcoidosis

6

Nephrocalcinosis from metastatic calcification consists of wedge shaped scars which microscopically show calcification within (1) as well as the (2)

1. tubular basement membrane 2. interstitium

7

Ultrastructurally (electron microscopy), the calcium is present within (1)

Nephrocalcinosis from metastatic calcification 1. mitochondria

8

Dystrophic calcification is found in instances where there is (1), and calcification occurs as a result

1. injury or infection

9

Nephrolithiasis often damage the (1) to cause (2)

1. transitional epithelium 2. hematuria (blood in the urinary tract)

10

term that refers to intermittent pain

colic

11

Nephrolithiasis can distend the ureter intermittently, causing ?

renal colic

12

In some instances, the stone results from an elevated serum concentration of (1), which directly leads to increased urinary concentration of the insoluble crystals resulting in stone formation

uric acid or cysteine

13

In the case of the most common type of stones, calcium stones, there is often (1) in the absence of (2)

hypercalcuria hyper-calcemia.

14

Another type of calcium stone begins as a (1) stone, which is then surrounded by calcium precipitates as the stone is enlarging

uric acid

15

(1) tend to be harder than calcium phosphate stones, and can injure the (2) as they form and pass into the ureter

1. Calcium oxalate stones 2. renal pelvis

16

Although a bit counterintuitive, (1) can sometimes cause more symptoms because they can pass into the ureters causing pain

smaller stones

17

Urea splitting bacteria (proteus or providencia) produce (1) stones which are also known as (2). These can be very large stones that form a cast of the (4) and are known as (3) because of their resemblance to deer antlers.

1. magnesium ammonium phosphate 2. struvite 3. staghorn calculi 4. renal pelvis

18

Uric acid stones form in about one-fifth of patients with (1), but can also be found in patients with (2)

1. hyperuricemia (elevated serum uric acid) 2. normal serum uric acid but elevated uric acid in urine (hyperuricaciduria).

19

Histologically, there can be yellow streaks as (1) form in the (2) and can lead to tophus formation with (3) surrounding the crystals

1. uric acid crystals 2. renal calyces and pelvis 3. macrophages

20

There can also be obstruction of more proximal tubules leading into the calyces which can produce dilated tubules

Uric acid stones

21

Disorders which produce elevated amounts of purines in blood such as the tumor lysis syndrome (when cancer patients have cancer cell lysis from chemotherapy) can lead to?

hyperuricaciduria and uric acid stones

22

In addition, (1) intoxication due to exposure to metal alloys containing (1) leads to decreased uric acid urinary elimination which can elevate the concentration of uric acid in serum, urine, or both, leading to uric acid stones. This condition is called (2)

1. lead 2. saturnine gout

23

Histologically there can be yellow streaks as the conditions responsible for stone formation include?

low urine flow, urine pH (some stones form more readily in more acidic and others in more alkaline urine), and super-saturation of the component which forms the crystal.

24

A relatively common cause of renal stones in children is (1) which results from a mutation in (2)

1. cystinuria 2. the dibasic acid transporter

25

Cystinuria also causes poor transport of other basic amino acids such as (1) but cysteine is the crystal that forms the stones

1. lysine and arginine

26

Fanconi’s anemia has a number of abnormalities, including defects in the (1) that can lead to (2)

1. proximal tubule 2. renal tubular acidosis and formation of renal stones

27

Dent’s disease can result from mutations in specific (1) which leads to increased (2) in urine and ultimately to formation of renal stones

1. chloride channels 2. calcium and phosphate

28

Less than a quarter of stones occur as a consequence of infections within the (5)

5. renal pelvis or collecting ducts

29

Nephrocalcinosis effects ____ & ____ causing destruction of the tubular system.

tubules and interstitial area between the tubular cells

30

Clinical signs of nephrocalcinosis

cause tubular defects aka destruction of the tubular system resulting in: Impaired concentration ability (1st thing lost in renal disease), Salt wasting (loss of sodium) Renal tubular acidosis

31

•Hypercalcemia (and thus METASTATIC) leading to nephrocalcinosis due to:

•(1) 

•(2) 

•(1) ↑resorption of calcium from bone (various causes)

•(2) ↑Intestinal absorption of calcium (various causes)

32

•Wedge-shaped scars mixed w/ relatively normal renal tissue.

Nephrocalcinosis gross

33

EM--> nephrocalcinosis, what do you see (be specific)

•MITOCHONDRIA of renal tubular epithelial cells contain abundant calcium deposits.

34

Smaller stones are MOST HAZARDOUS; why?

•HAZARDOUS—b/c they pass into the ureters and  produces colic.

35

First clinical sign of larger stones

HEMATURIA

36

Stones also predispose to ___; both by obstructive nature and by the trauma they produce

superimposed infection

37

_____refers to stones in more downstream parts of the urinary system

Urolithiasis

38

Treatment of kidney stones:

1 and 2

Ultrasonic disintegration (lithotripsy) and endoscopic removal

39

•are hard and sharp --> cause injury to the renal pelvis (so will see hematuria).

calcium oxalate

40

Calcium oxalate stones (different lab changes)

  1. Hypercalcemia AND hypercalciuria (RARE; 5%)
  2. ______

•Most common; 55%; important to check urine!!

3. •Increased uric acid secretion--> _____

4. Hyperoxaluria

Hypercalciuria w/ NO hypercalcemia;

MIXED URIC ACID & CALCIUM STONE

41

why do you get mixed uric acid and calcium stone?

urate crystals act as nidus around which calcium salts precipitate

42

_____-->either hereditary (primary ____) or acquired by intestinal overabsorption in pts w/ GI diseases or on vegan diets

Hyperoxaluria

43

•softer and paler due to DYSTROPHIC CALCIFICATION

•Calcium Phosphate Stones

44

•Elevated serum uric acid due to:

1. 

2.  Hepatic catabolism of ____ released from ____ of necrotic cells (tumor lysis syndrome—seen with chemotherapy pts + myeloproliferative disorder).

3.  Chronic lead intoxication

1. ↑production (gout), ↓excretion.

2.  Hepatic catabolism of purines released from DNA of necrotic cells (tumor lysis syndrome—seen with chemotherapy pts + myeloproliferative disorder).

3.  Chronic lead intoxication

45

Chronic lead intoxication interferes w/ ____ by proximal tubules --> uric acid accumulates producing ____

uric acid secretion; saturnine gout

46

•Stones are smooth, hard, yellow and <2cm.

Uric acid stones are radiolucent

uric acid stone

47

•Complication of uric acid:

___: uric acid crystal precipitation can obstruct the collecting ducts as a result of increased uric acid concentration in the acidic pH of urine

ARF (Acute Renal Failure)

48

•Acute urate nephropathy: precipitated uric acid in the collecting ducts is seen grossly as ____.

Tubules ____ to the obstruction are dilated

yellow streaks in the papillae; proximal

49

•Histology of uric acid:

•____->a focal accumulation of urate crystals surrounded by inflammatory cells (macrophages)

•Urate crystals in the adrenal medulla w/ ____ around them.

____ around the crystals (host response

Gouty tophus; giant cells; Fibrosis

50

Xanthine Stones: XO deficiency/XO inhibitor (allopurinol and febuxostat

treatment for uric acid stones

51

____ stones represent a significant proportion of childhood calculi and occur w/ hereditary cystinuria

Cystine

52

Cystinuria

•Due to mutation in the ____ leads to decreased reabsorption of cystine and other dibasic amino acids (3 things).

dibasic acid transporter; lysine, ornithine, and arginine

53

•Mutations in SLC 3A1 (recessive)

Mutations in SLC7A9 (dominant)

Cystine stones

54

Congenital mutations in chloride channels --> present w/ kidney stones due to hypercalciuria, aminoaciduria, and phosphaturia

Dent's Syndrome

55

Dent's--> Congenital mutations in chloride channels; present w/ kidney stones due to __, __, and __

hypercalciuria, aminoaciduria, and phosphaturia

56

Has a number of abnormalities, including defects in energy and certain ion channels in the PROXIMAL TUBULE --> that can lead to renal tubular acidosis and formation of renal stones

Fanconi's anemia

57

Fanconi's:

Has a number of abnormalities, including defects in energy and certain ion channels in the ___ --> that can lead to ____ and formation of renal stones

PROXIMAL TUBULE; renal tubular acidosis

58

Urinary loss of AMINO ACIDS, phosphate

Fanconi's anemia