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Flashcards in Urolithiasis Deck (50)
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1

Define Nephrolithiasis

Stones in the kidney, ureter, or bladder of the urinary tract

2

1st Phenomena of Pathophysiology of Stones

Supersaturation of urine by stone-forming constituents
Crystals or FB can act as a nidus

3

2nd Phenomena of Pathophysiology of Stones

More likely responsible for calcium oxalate stones
Deposit of stone material on a a renal papillary calcium phosphate nidus
Calcium phosphate precipitates the basement membrane & erodes interstitium & accumulate in sub epithelial space
Subendothial deposits erode through the papillary urothilium
Stone matrix, calcium phosphate, & calcium oxalate deposit on nidus to create stone

4

Etiology of Nephrolithiasis

Low fluid intake with low volume of urine production
Hypercalcuria

5

Reasons for Hypercalcuria

Increase in intestinal absorption of calcium
Excess reabsorption of calcium from bone
Inability of renal tubules to properly reclaim calcium in glomerular filtrate

6

Types of Stones

Calcium
Uric acid
Cystine
Struvite
Xanthine

7

Risk Factors of Nephrolithiasis

Family history
Gout
Primary hyperparathyroidism

8

Age for Highest Risk of Nephrolithiasis

Most: 20-49 years old
Peak: 35-45 years old

9

Clinical Presentation of Nephrolithiasis

Pain
Infection
Hematuria
Acute onset severe flank pain radiating into the groin
Gross/microscopic hematuria
N/V
Fever/chills

10

Workup of Nephrolithiasis

UA: hematuria, bacteria or leukocytes
CBC: elevated WBCs
CMP: electrolytes, BUN/Cr levels, parathyroid hormone level with ionized calcium level
24 hour urine: identify urinary risk factors
Imaging: KUB, renal US, CT without contrast

11

Most Common Findings on 24 Hour Urine

Hypercalcuria
Hyperoxaluria (oxalate)
Hyperuricosuria (uric acid)
Hypocitraturia (citrate)

12

What does the 24 hour urine evaluate?

Volume
pH
Calcium
Sodium
Phosphate
Citrate
Uric acid
Cystine
Oxalate
Magnesium

13

KUB & Nephrolithiasis

Good for: monitoring stones, large stones, radiopaque stones
Less radiation
Inexpensive

14

Renal Ultrasound & Nephrolithiasis

Good for diagnosing hydronephrosis
Difficult to see ureteral stones
No radiation
Test of choice for pregnancy

15

CT & Nephrolithiasis

Gold standard for stones

16

Treatment of Nephrolithiasis Depends on

Stone size
Infection with obstructing stone
Solitary kidney
Pregnancy
Patient preference
Surgery
Medication
Diet

17

Stone Size & Treatment of Nephrolithiasis

8mm 0-10% passage on own

18

Infection with Obstructing Stone & Treatment of Nephrolithiasis

CONSULT UROLOGIST
Needs ureteral stent placement
Worry about sepsis

19

Solitary Kidney & Treatment of Nephrolithiasis

CONSULT UROLOGIST
Stent placement same day
Stone removal

20

Pregnancy & Treatment of Nephrolithiasis

Stent placement
Pain medication

21

Patient Preference & Treatment of Nephrolithiasis

Try to pass on won
Alpha-blocker (Flomax, Doxazosin)
NSAIDs & pain medication

22

Surgical Treatment of Nephrolithiasis

Stent placement vs. percutaneous nephrostomy
Extracorporeal Shockwave Lithotripsy (ESWL)
Uteroscopoy
Percutaneous Nephrostolithotomy (PNL)
Open nephrostomy

23

Medication Treatment of Nephrolithiasis

Flomax
IM/IV Ketorolac
Hydrocodone or oxycodone
IM/IV metoclopramide
Morphine
NSAIDs

24

Diet in Treatment of Nephrolithiasis

Increase fluids
Avoid excess salt & protein intake
Moderation in food high in oxalate
Do NOT limit calcium

25

Foods High in Oxilate

Green leafy vegetables
Chocolates
Tea

26

Calcium Oxalate Stones

Most common stone
Formation caused by high calcium & high oxalate excretion

27

Uric Acid Stones

Most common radiolucent stone
Low urine volume and acidic urine pH promote precipitation of uric acid

28

Describe Calcium Oxalate Crystals

Diamond looking

29

Describe Uric Acid Crystals

Flattened hexagonal appearing

30

Cystine Stones

Genetic cause of kidney stones
White pearly looking stones