Duke PA Nephrolithiasis
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| nephrolitiasis is a common cause of ___ in the US | morbidity
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| the peak incidence of nephrolithiasis is in the age group of ___ | 20-45
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| ___ stones are most common accounting for 75% of all stones | calcium
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| most calcium stones are | calcium oxylate
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| ___ stones require an alkaline pH and are therefore less common | calcium phosphate
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| patients with nephrolithiasis usually have | flank pain radiating to the groin on the same side
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| nephrolithiasis may sometimes be associated with | N/V, polyuria, dysuria, and ileus
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| initial screening for kidney stones should include | electrolytes, creatinine, serum calcium, phosphate and uric acid
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| management of nephrolitiasis requires | identifying the specific type of stone
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| conditions that may lead to calcium phosphate stone formation | RTA, primary hyperparathyroidism, milk-alkali syndrome
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| after 20 years of follow up <__% of patients remain stone free | 10
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| all patients with nephrolithiasis should be advised to consume approximately __L of fluid per day | 3
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| the two dietary restrictions that have been benificial in reducing recurrence of stones | restricting intake of animal protein and sodium
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| __% of renal stones are passed spontaneously | 90
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| stones that are wider than __mm are unlikely to pass | 8
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| extracorporeal shock wave lithotripsy treatment is more benificial in patients with | renal pelvic, or upper ureteral stones
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| ureteroscopy with basket retrieval or ultrasonic lithotripsy may be more successful in patients with | lower ureteral stones
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| calcium stones __mm have a 50% chance of passing spontaneously | 4-7
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| surgical intervention is indicated if a stone is unlikely to pass on its own or | when serial studies show a loss of renal function, or increasing hydronephrosis, when infection is present, and when pain is intractable
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| the main risk factors for uric acid stones | dehydration, persistently acidic urine, increased secretion associated with RTA
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| the mainstay of uric acid stone treatment is | too increase volume and alkalinize the urine in an effort to reduce precipitation of uric acid
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| alkalinization can be achieved during the day with | oral sodium bicarbonate
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| to achieve alkalinization at night when urine is most acidic | acetazolamide may be used
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| the majority of __ stones dissolve within a few weeks with proper therapy | uric acid
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| patients with ___ stones usually have a history of several UTI's treated with multiple courses of antibiotics | Magnesium Ammonium Phosphate (struvite)
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| percutaneous nephrolithotomy is currently the primary surgical intervention of choice for __ stones | Magnesium Ammonium Phosphate (struvite)
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| Cystine stones can be dissolved by | maintaining high urine output as well as by alkalinizing the urine
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| foods high in oxylate | nuts, spinach, black tea, sweet potatos
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| three most common places for stones to get stuck | ureteropelvic junction, crossing of iliac artery, ureterovesical junction
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| the ureter contracting against a stone causing flank pain that may radiate toward the groin, and genitalia | renal colic
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| signs of lower UTI | frequency, urgency, dysuria, fever
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| renal stones at the ureterovesical junction can present with | signs of a lower UTI
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| radiolucent stones | cystine stones, uric acid stones
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| IVP is good for viewing | filling defects in the urinary system, radiolucent stones
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| renal stone protocol CT | does not use contrast
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| in between plain films and renal stone protocol CT | TOMO
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| stone that fills out the kidney pelvis and 2/3 of the calyces | staghorn stone
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| ideal candidate for SWL | small stone (<1.5 cm), mid or upper pole location, normal renal anatomy, no obstruction
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| Sometimes 1st line Tx for stones ≤ 2 cm located to the mid ureter | Ureteroscopy
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| complications of ureteroscopy | infection, ureteral tear (rare avulsion), ureteral stricture
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| in between plain films and renal stone protocol CT | TOMO
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| stone that fills out the kidney pelvis and 2/3 of the calyces | staghorn stone
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| ideal candidate for SWL | small stone (<1.5 cm), mid or upper pole location, normal renal anatomy, no obstruction
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| Sometimes 1st line Tx for stones ≤ 2 cm located to the mid ureter | Ureteroscopy
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| complications of ureteroscopy | infection, ureteral tear (rare avulsion), ureteral stricture
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