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DU PA Kidney Stones

Duke PA Nephrolithiasis

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