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DU PA Kidney Stones
Duke PA Nephrolithiasis
| Question | Answer |
|---|---|
| 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:
Afran
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