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Flashcards in stone disease Deck (44):
1

what are most stones made out of?

CA

2

what stones are radioopaque?

Ca

3

most important factors for urinary stone development?

high protein,
high salt
inadequate hydration

4

acidic urine makes what kind of stones?

uric acid or cystine stones

5

alkaline urine produces stones how?

contributes to UTI prodoucing (proteus, klebsiella) making struvite stones

6

what is the MC stone?

calcium oxalate stones

7

what is the strongest promoter of stone formation?

urinary oxalate

8

what are the two causes of increased oxalate?

not enough calicium in the gut or >2 g/day ascorbic acid (vit C)

9

what helps prevent calcium phosphate and calcium oxalate crystallization?

increased urinary citrate that binds w/ calcium and doesnt allow stone formation. there is more citrate in alkalotic urine

10

what are risks for calcium oxalate and calcium phosphate stones?

high sodium, high animal protein diet, dehydration, hypercalciuria, low urine citrate

11

what causes struvite stones?

MC women w/ recurrent URIs w/ urease producing bacteria

12

what are struvite stones?

magnesium-ammonium-phosphate stone

13

what are urease-producing bacteria?

proteus, pseudomonas, providencia, klebsiella, staphylococcus, and mycolplasma

14

what is the acidity for calcium oxalate stones?

>7.2

15

what risk does calcium phosphate have that calcium oxalate does not?

increased urine alkalinity

16

stone frequently composed of struvite that's in the renal pelvis and extends into at least 2 calyces

staghorn calculi

17

what is the only amino acid insoluble in urine?

cystine

18

what pH do cystine and uric acid stones form in?

pH <5.5

19

what stones are radioopaque?

struvite
calcium

20

what stones are radiolucent?

cystine
uric acid stones

21

what increases the risk of uric acid stones?

think people that have malignancy or are undergoing malignancy treatment

myeloproliferative disorders

22

clinical findings of stones?

colic pain: obstructing

sudden (may awaken from sleep)
severe, unremitting flank pain
+/- N/V
constantly moving around looking for comfort
hematuria
CVA tenderness
pain may refer as it moves down ureter

23

if the stone is lodged at the ureterovesical junction what are the symptoms?

marked urinary urgency and frequency

24

what pH will you see calcium phophate stones?

>7.5

25

what is the gold standard imaging for stones?

non contrast CT

26

What imaging for stones if the patient is pregnant?

Renal US

27

What is the “standard of care” imaging for stones for a pregnant woman?

Non-contrast CT

28

Asymptomatic stone treatment w/ no signs of infection?

Nothing

29

What size stones will pass spontaneously?

<= 5-6 mm

30

What is acute treatment for stones?

Hydration: oral first then IV

Medications: analgesics (NSAID, but be careful because if they are taking an ACEI in scenario it will be evident that it is safe to use an NSAID if not then use narcotics), anti-emetic, alpha blocker

31

What patients would you refer for stones?

Infection (bacteremia, sepsis)
Obstruction
Intractable pain (admit and control)

N/V
Stone size >=6mm
Fails to pass w/in 4 weeks
Pregnant
Immunocompromised
Fail to pass in 4 weeks

32

Who gets emergent urologic evaulation and drainage?

Obstructive urinary calculi w/ fever and infected urine

33

What works well on stones in the renal pelvis or upper 2/3 of ureter and size <1.5 cm?

Extracorporeal Shock wave lithotripsy: DISCONTINUE NSAIDS 3 DAYS PRIOR BECAUSE OF BLEEDING

34

What can be placed following ESWL to facilitate passage of stones?

Ureteral stent

35

What is good for stone removal in lower 1/3 of ureter?

Ureteroscopic stone extraction

36

What is good for stones in renal collecting system, upper 2/3 of ureter, and >2cm?

Percutaneous nephrolithotomy

37

What can be used to remove stones in patients w/

1. Complex anatomy
2. Obstruction
3. Large infected struvite stones?
(I think he said stag horn or pregnant in review?)

Open stone surgery

38

When is imaging maybe unnecessary for stones?

Recurrent

39

What is the bottom line treatment for acute stone treatment?

Fluids
Pain control
Confirm stone
Admit (failure to control pain, infection, comorbidity)
Refer: (infection, large stone, comorbidity)

40

What are the labs for recurrent stones?

24 hr. Urine collection assess:
- total volume
- pH
- Urinary excretion of Ca, oxalate, citrate, sodium potassium and creatinine

Serum PTH, Uric acid r/o primary hyperparathyroidism or gout

41

What are prevention measures for stones?

Decrease salt

Decrease animal product

DO NOT RESTRICT CA

increase Bran and water

Avoid soda (high phosphate)

Avoid Vit C (ascorbic acid metabolism- inc. oxalate)

Decrease dietary oxalate

42

Treatment for recurrent stones?

If high calcium
Thiazide diuretics (HCTZ, chlorthalidone)

If low urinary citrate or low urine pH
Potassium citrate therapy
Citrate inc for Ca
Raise pH in uric acid or cystine stone formers

43

How much should a patient urinate daily?

1.5-2 L/day

44

What is the f/u for stones?

Chronic:
Repeat 24 hr urine in 6 months

Repeat stone analysis if interventions are failing

Consider yearly CT to assess for new formation