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UROLITHIASIS Flashcards

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1
Q

kidney stones: ____________ affected more than ____________

A

men affected more than women

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2
Q

kidney stone prevalence increases with ________

A

age

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3
Q

kidney stone age of initial presentation

A

30s-50s

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4
Q

what are the 5 major types of kidney stones

A

1) calcium oxalate
2) calcium phosphate
3) struvite
4) uric acid
5) cystine

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5
Q

Stone formation is thought to be from

A

Supersaturation of calcium

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6
Q

stones Form in the _________and get extruded at the ________

A

interstitium

renal papilla

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7
Q

the most common kidney stone

A

calcium oxalate

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8
Q

RISK FACTORS FOR KIDNEY STONES

A

Areas of high humidity
Elevated temperatures
Incidence greater in the summer months
Sedentary lifestyle
High protein and salt intake
Genetic factors – particularly with the calcium stones
Examples: cystinuria, distal renal tubular acidosis (75% of pts)

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9
Q

most common risk factor for kidney stones

A

decreased fluid intake

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10
Q

urine composition & diet risk factors for calcium stones

A

Urine composition for Calcium stones

  • Hypercalcuria
  • Hyperoxaluria
  • Hypocitraturia

Diet

  • Low calcium intake
  • High oxalate intake
  • High animal protein intake
  • High sodium intake
  • Low fluid intake
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11
Q

risk factors for uric acid stones

A

Chronic diarrhea
Gout
Diabetes

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12
Q

risk factors for struvite stones

A

Urease-producing organisms

  • Proteus & Klebsiella
  • Form Staghorn calculi
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13
Q

symptoms of kidney stones

A

Acute and severe colic
May awaken pt from sleep
Localized to the flank
May be referred to the groin
May be associated with nausea and vomiting
Patients are writhing in pain trying to find a comfortable position
Urinary urgency, dysuria and frequency
(If stone becomes lodged at the ureterovesicular junction)
In men the pain may radiate to the tip of the penis

HEMATURIA

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14
Q

work up for kidney stones

A
  • UA with culture
  • urine pH
  • CBC
  • BMP (chem 8)
  • pregnancy test
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15
Q

normal urine pH

A

5.8 - 5.9

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16
Q

which stone type is genetic

A

cystine

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17
Q

struvite stones are made of

A

magnesium ammonium phosphate

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18
Q

think proteus / klebsiella = think which stone

A

struvite (staghorn!)

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19
Q

urine pH < 5.5 = which stone/s

A

uric acid stones

cystine stones

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20
Q

urine pH 5.5-6.8 = which kidney stone/s

A

calcium oxalate stones

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21
Q

urine pH > 7.2 = which kidney stone/s

A

struvite or calcium phosphate stones

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22
Q

pts need to ________ their urine at home for analysis

A

strain

to catch stones

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23
Q

for recurrent stone formers (or family history) = do full metabolic work up

Study These Flashcards
A

Serum PTH, calcium, uric acid, ‘lytes, creatinine, BUN

24 h urine collection
- Volume, pH, calcium, uric acid, oxalate, phosphate, sodium, citrate

24
Q

DIAGNOSIS OF KIDNEY STONES

Study These Flashcards
A
  • CT/ultrasound
  • KUB

CT and ultrasound will show obstruction and hydronephrosis

ultrasound = good cheap fast test for present of stone

25
what does KUB detect
only large radiopaque stones (calcium & struvite) misses radiolucent stones doesn't detect obstructions
26
initial diagnostic test for kidney stones
ultrasound
27
common sites where kidney stones are lodged
- ureteropelvic junction (between kidney & ureter) - as ureter crosses iliac artery - ureterovesicular junction (between ureter & bladder)
28
narrowest point of urinary tract
ureterovesicular junction
29
medical emergency = Any obstructing stone with associated ___________
infection
30
acute therapy for kidney stones
IV hydration Pain meds (ketorolac/Toradol, morphine) Antiemetic (metoclopramide/reglan)
31
when to admit the pt for kidney stones
Intractable nausea and vomiting or pain | Obstructing stone with signs of infection
32
gold standard diagnosis for kidney stones
noncontrast abdomen/pelvic CT
33
REASONS FOR UROLOGICAL CONSULT FOR KIDNEY STONES
⦁ evidence of urinary obstruction ⦁ urinary stone with associated flank pain ⦁ anatomic abnormalities or solitary kidney*** ⦁ concomitant pyelonephritis or recurrent infection
34
Which of the following is the greatest risk factor for kidney stone formation? a. High sodium diet b. Low fluid intake with low urine volume c. Lower socioeconomic status d. ETOH abuse
b. Low fluid intake with low urine volume
35
``` What type of stone composition is the most common? Select one: a. Uric acid b. Calcium oxalate c. Cystine d. Xanthine ```
b. Calcium oxalate
36
A 54 year-old female with a past medical history of headaches, left nephrectomy for cancer, and ovarian cysts presents to the ER after a motor-vehicle crash. A CT scan done revealed an incidental 4mm right ureteral stone. The patient is asymptomatic and no other findings are found. What is the best option for this patients ureteral stone? Select one: a. Send her home with Flomax and let her know she will pass this on her own b. Do nothing since this patient is asymptomatic c. Give her pain medication and send urine sample for culture. d. Consult Urology
d. Consult Urology | - only has 1 kidney!
37
``` A 43 year old male presents to your office just recently passing his fourth stone. Which diagnostic test is most useful to identify the cause of his recurrent stone formation? Select one: a. UA dip with micro b. Renal biopsy c. 24 hour urine d. Urine cytology e. CMP ```
24 hr urine
38
A 48 year old female with a history of right flank pain on/off for 3 days and recent altered mental status presents to the ER. Her spouse reports that she has had fever/chills, dysuria, N/V, dark colored urine (that has decreased in the past 24 hours), and a history of nephrolithiasis. Her vital signs are BP 100/55, HR 115, RR 27, and Temp. 103.1. Imaging study confirms a 6 mm R obstructing ureteral stone. What is the next best step in the management of this patient? Select one: a. IV fluids, pain management, oral antibiotics, discharge to home and follow up with urology the following day b. IV fluids, pain management, and Flomax. c. Hospital admission for IV fluids, pain management, antibiotics and urgent urology consult d. Oral pain management, antibiotics, and 24 hour urine collection
c. Hospital admission for IV fluids, pain management, antibiotics and urgent urology consult infected!
39
``` CHANCES OF KIDNEY STONE PASSAGE 1mm 2-4mm 5-7mm 7-9mm >9mm ```
``` 87% for 1 mm 76% for 2-4 mm 60% for 5-7 mm 48% for 7-9 mm 25% for stones ≥9 mm ```
40
RX to help with kidney stone passage
⦁ Tamsulosin 0.4mg qd ⦁ NSAIDS - Ibuprofen 600mg TID ⦁ Low dose prednisone 10mg qd x 5 days Tamsulosin 0.4mg qd - alpha blocker - helps relax smooth muscle to allow stone to pass through more easily
41
THERAPEUTIC INTERVENTION IS NEEDED FOR KIDNEY STONES WHEN:
⦁ failure to pass stone in 4 weeks | ⦁ fever, intolerable pain, persistent nausea or vomiting
42
SURGICAL TREATMENT FOR KIDNEY STONES
⦁ Ureteroscopy with stent placement ⦁ ESWL = extracorporeal shock wave lithotripsy ⦁ Percutaneous Nephrolithotomy (PNL)
43
PREVENTION OF KIDNEY STONE FORMATION
⦁ increase fluid intake** (most important) ⦁ avoid sodium ⦁ reduce animal protein consumption ⦁ limit foods high in oxalate (beer, tea, coffee)
44
STONE ANALYSIS - IF DUE TO HYPERCALCURIA
- Absorptive ⦁ Types I, II, III ⦁ Type I can be treated with Thiazides x 5 years or cellulose phosphate - Renal hypercalciuria ⦁ long term rx with thiazides - Resorptive ⦁ Hyperparathyroidism
45
STONE ANALYSIS
o HYPERCALCURIA - Absorptive ⦁ Types I, II, III ⦁ Type I can be treated with Thiazides x 5 years or cellulose phosphate - Renal hypercalciuria ⦁ long term rx with thiazides - Resorptive ⦁ Hyperparathyroidism o HYPERURICOSURIC o HYPEROXALURIC ⦁ chronic diarrhea from Inflammatory bowel disease o HYPOCITRAURIC ⦁ persistent metabolic acidosis (Renal tubular acidosis, chronic diarrhea, chronic HCTZ)
46
almost all bladder stones occur in
MEN
47
bladder stones are ______ common than kidney stones
LESS
48
Most common bladder stone
URIC ACID STONE
49
Surface of bladder stones range from smooth & faceted to jagged & spiculated (_________)
JACK STONE
50
bladder stones (men) are usually due to
urinary retention secondary to BPH
51
RISK FACTORS FOR BLADDER STONES
``` ⦁ bladder diverticulum ⦁ bladder outlet obstruction (Most common)** ⦁ Neurogenic bladder ⦁ UTIs ⦁ Catheters ```
52
MOST COMMON RISK FACTOR FOR BLADDER STONES
BLADDER OUTLET OBSTRUCTION
53
PRESENTATION OF BLADDER STONES
``` ⦁ abdominal pain/pressure ⦁ hematuria or dark colored urine ⦁ difficulty urinating ⦁ urgency/frequency ⦁ interruption of stream ⦁ penile discomfort ⦁ UTI ```
54
physical exam for bladder stones
usually an enlarged prostate present (have BPH)
55
diagnosis of bladder stones
- bladder or pelvic xray | - cystoscopy
56
labs for bladder stones
⦁ UA with culture
57
TREATMENT FOR BLADDER STONES
- Cystoscopy in office for small stones - Surgery ⦁ Cystolithalopaxy ⦁ Cystolithotomy ⦁ TURP ⦁ Simple prostatectomy - Potassium citrate

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