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Urinary stones Flashcards

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1
Q

3rd MC urinary tract D/O

A

Urinary stones

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2
Q

Urinary stones pop?

A

M > F (2.5:1)

30-50s

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3
Q

Urolithiasis def

A

Stone formations anywhere in urinary tract

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4
Q

Nephrolithiasis def

A

Stones in kidneys

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5
Q

Ureterolithiasis

A

Stones in the ureters

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6
Q

Urinary calculi composition

A

Polycrystalline aggregates of crystalloid/organic matrix

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7
Q

Basic pathophysiology of stone formation

A

Result of urinary supersaturation of solutes

-low fluid intake, low UA volume = high solutes

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8
Q

Most stones are compsed of?

A

Calcium = radiopaque

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9
Q

Most important factors of stone development

A

High protein/salt intake
Inadequate hydration
Sedentary

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10
Q

Geographic factors of stone development

A

High humidity

INC temp

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11
Q

Genetic predisposition condition? 3

A

Homozygous Cystinuria
Auto rec D/O
INC cysteine excretion

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12
Q

Acidic urine contributes to

A

Uric acid or cystine stones

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13
Q

Alkaline urine contributes to

A

UTI - urease producing organisms
-proteus / klebsiella
=strucite stones

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14
Q

5 major stone types

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Cystine
  4. Struvite AKA staghorn calculi
    (-Mg ammonium phosphate)
  5. Uric acid
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15
Q

MC urinary stone

A

Calcium Oxalate Stones

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16
Q

Calcium Oxalate pH range

A

5.5-6.5

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17
Q

Increased risks of developing Calcium Oxalate

A

High sodium/protein
Dehydrated
Hypercalceuria
Low urine citrate

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18
Q

XR attenuation of Calcium Oxalate?

A

Radiopaque

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19
Q

Citrate interaction w/ calcium

A
  1. UA citrate binds calcium
  2. Decreases calcium
  3. Prevents calcium phosphate/oxalate stones
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20
Q

Acidic urinary citrate level is?

A

Decreased

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21
Q

Alkalosis urinary citrate level is?

A

Increased

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22
Q

Calcium phosphate pH level

A

> 7.5 pH alakaline urine

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23
Q

Calcium phosphate Increased RFs?

A

High sodium/protein
Dehydration
Hypercalcuria
Low urine citrate

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24
Q

Calcium phosphate XR attenuation?

A

Radiopaque

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25
Struvite stones are composed of?
Mg-ammonium-phosphate
26
Struvite stone MC pop?
Women w/ recurrent UTIs w/ urease producing bacteria
27
Types of urease producing bacteria?
``` Proteus / klebsiella Pseudomonas Providencia Staph Mycoplasma ```
28
Struvite stone pH range?
>7.2
29
Struvite stone XR attenuation?
Radiopaque/radioense
30
Struvite calculi develops where?
Upper urinary tract | W/in Renal pelvis extending into 2 calyces
31
What is the only amino acid insoluble in urine?
Cystine
32
Cystine stone pH of UA?
<5.5
33
What type of genetic predisposition is cystinuria?
Auto rec D/O
34
Cystine stone XR attenuation?
Radiolucent
35
Uric acid stone RFs?
Hyperuricemia Myeloproliferative D/O Malig w/ uric acid forming Abrupt/dramatic wgt loss
36
Uric acid stone pH range?
<5.5
37
Uric acid stone XR attenuation?
Radiolucent
38
Obstructing stones S/S
Colic pain - radiates anteriorly over ABD Sudden onset - may wake from sleep Severe unremitting flank pain Ass/w n/v Pt constantly moving looking for position of comfort Hematuria CVA TTP
39
As stones pass down ureters may change to?
Referred ipsilateral groin pain
40
Stones lodged at ureterovesical jx S/S?
Urinary urgency.freq | Males - pain at penis tip
41
Does size of stone correlate w/ S/S severity?
No
42
DDx for stones?
Bleeding - clots=temp obstruct Pyelonephritis - flank pain and fever (not expected unless obstruct w/ infection) GYN flank pain - ectopic preg, preg, ruptured ovarian cyst, ovarian torsion. AAA - ruptured or leaking Mesenteric ischemia - ABD w/out peritonitis S/S initally Herpes zoster - flank pain +rash/lesion - no hematuria Drug-seeking - false pain/hematuria
43
Urinary stone labs
``` UA -hematuria 90% -pH <5.5 - uric acid/cysteine stones -pH 5.5-6.8 - calcium oxalate stones -pH >7.2 - struvite stones -pH >7.5 - calcium phosphate stones CHEM 17 STONE ANALYSIS - strainer ```
44
Imaging gold standard for urinary stones?
Non-contrast CT | -all stones visible
45
Stones seen on KUB XR
Calcium = radiopaque | Cannot exclude stone if NEG
46
Renal U/S is a good alternative image if?
Pt is pregnant Safe, good accuracy. Not standard of care
47
Acute TXT of asymptomatic pt w/ no infection
no TXT
48
Majority of Acute TXT id conducted how? Intervention?
Outpatient Conservative- 1. Hydration - INC H2O - IVF if needed 2. Pain - NSAID,narcs 3. Antimetic - Ondansetron/promethazine 4. Alpha-blk agents (pass it) - Alfuzosin/tamsulosin
49
What size stone typically pass spontaneosly?
<=5-6mm
50
Stone referral indications
``` Infection Obstruction Intractable pain (admit) Persistent N/V >=6mm size Fails to pass w/in 4wks Kidney ABNL/single Pregnant Immunocompromised PMHx severe renal Dz ```
51
Pt w/ obstructed urinary calculi w/ fever and infected urine req?
Emergent urologic eval and drainage -pus under pressure-
52
Extracorporeal shockwave Lithotripsy (ESWL) works best when?
Stones are in renal pelvis or upper 2/3 of ureter and size <1.5cm
53
TXT of choice if stones require advanced intervention?
TOC = ESWL 75%
54
Before performing a ESWL what is req?
D/C NSAIDs 3 days prior (decrease bleed risk0
55
What may be used post ESWL to help facilitate stone passage?
Ureteral Stent
56
Ureteroscopic stone extraction attribute?
Remove Stones in lower 1/3 of ureter (NL anatomy)
57
Percutaneous nephrolithotomy attributes
Remove Stones in renal collecting system or upper 2/3 of ureter w/ size >2cm
58
Open stone surgery is reserved for who?
Pts w/ complex anatomy, obstruction, large infected struvite stones
59
Acute pts bottom line management
``` Push fluids (PO/IV) Pain control Confirm stone PRN Admit PRN Refer PRN ```
60
Recurrent stones lab w/u
24hr UA -volume, pH, composition Serum PTH and Uric acid -R/O hyperparathyroidism or gout
61
PVT strategies | Diet
DEC salt > INC Ca2+ UA DEC protein > INC Ca2+ and DEC citrate in UA Do not restrict Ca2+ intake (low calcium diet > increased risk of stones) INC bran/water -fiber > feceses Ca2+ excretion Avoid soda -high in phosphate > INC calcium phosphate formation Avoid VIT-C >2g/day -ascorbic acid metabolism = INC oxalate
62
Reducing calcium in diet physiology
``` DEC dietary Ca2+ > DEC oxalate binding in GI > INC serum oxalate > INC urinary oxalate > INC urinary calcium oxalate > stones ```
63
Recommended ca2+ intake
RDA 1000-1200 MG/d
64
Txt for recurrent stones
High UA calcium = thiazide diuretic (HCTZ, chlorthalidone) > DEC UA Ca2+ Low UA citrate or pH = potassium citrate therapy - raises citrate in Ca2+ stone formers - raises pH in uric acid/cystine stone formers
65
Very important orevention strategy
Hydrate -water
66
How much should a stone forming patient urinate?
1.5-2L/d
67
F/U for chronic stone formers?
6mo- RPT 24H UA to assess respone to intervention Q1yr CT to assess new forms RPT Stone analysis if TXT fail

Urology (7 decks)

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