Renal
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 90% of stones are: | radiopaque (visible): Ca & struvite). Uric acid & cystine stones are radiolucent.
🗑
|
||||
| Calcium oxalate or Ca phosphate stones | 75%; occasionally with chronic hypercalcemia (hyperparathyroidism)
🗑
|
||||
| Magnesium – ammonium – phosphate (struvite) stones: prevalence | 10-15%
🗑
|
||||
| Uric Acid / cystine stones: prevalence (%) | Uric Acid 5-8% of all kidney stones. Cystine 1-3%
🗑
|
||||
| Stones: DDx | AAA; Appendicitis; Tuboovarian Abscess (TOA); Ectopic Pregnancy
🗑
|
||||
| Urolithiasis: dx imaging | noncontrast CT (high sensitivity); US (hydronephrosis; good for PG); KUB (less specific)
🗑
|
||||
| Urolithiasis admission criteria | Infection / Sepsis; Complete Obstruction; Deteriorating renal fn; Intractable N/V; Solitary kidney; Very large or proximal stones
🗑
|
||||
| Renal stones lodge at: | UPJ (kidney stones), ureterovesicular junction/UVJ (bladder stones), or ureter at level of iliac vessels
🗑
|
||||
| Urolithiasis RFs | Prior stones, FH, low Ca/fluid intake, high oxalate/pro/Na intake, gastric bypass (RYGB); gout, DM, obesity, chronic UTIs, chronic diarrhea
🗑
|
||||
| Struvite stones form in pts with: | recurrent UTI (urease forming bacteria: proteus / klebsiella). Staghorn: often struvite
🗑
|
||||
| Urolithiasis clinical features | colicky flank pain +/- hematuria +/- fever/chills, N/V
🗑
|
||||
| Symptoms of renal stone in upper ureter: | radiate to anterior abdomen
🗑
|
||||
| Symptoms of renal stone in lower ureter: | radiate to ipsilateral groin, testes/ labia
🗑
|
||||
| Symptoms of renal stone in UVJ: | urgency, frequency, pelvic pain
🗑
|
||||
| ADPKD comorbididities | Berry aneurysms of the circle of Willis; cerebellar hemangioblastomas; hepatic cyst; hypertension (<50% of pts); valvular heart dz; divertic; renal failure
🗑
|
||||
| Meds contributing to stone formation | Antacids, carbonic anhydrase inhibitors (raise urine pH). Loop diuretics (increase urine Ca concentrations), thiazides (uric acid stones). Large doses vitamin C (-> hyperoxaluria)
🗑
|
||||
| Dietary factors on stone formation | Animal protein metabolism -> metabolic acidosis -> more Ca filtered/hypercaliuria. Meat (purine) -> uric acid. Green leafy (oxalate) -> Ca oxalate stones
🗑
|
||||
| Secondary causes of stones | HyperPTH, hyperthyroid, Cushing, granulomatous (sarcoid/TB/dissem candida), immobility, vit D intox, bone dz
🗑
|
||||
| Kidney stone dx | Stone analysis to ID. Noncontrast CT is TOC. US can show obstruction & hydro. 24hr urine, Urine Ca:Cr ratio. Check PTH in chronic pt if Ca elevated.
🗑
|
||||
| Kidney stone mgmt | IV fluids, analgesia. Most <5mm stones pass spontaneously. 5-10mm may need removal. Diet to lower Ca/ oxalate
🗑
|
||||
| UA findings in stones | pH <5.0 = uric acid & cystine. pH > 7.2 = struvite
🗑
|
||||
| Stones removed by: | lithotripsy (ESWL) or ureteroscopy w/extraction. Stones >10mm may require admission for lithotripsy or percutaneous nephrolithotomy
🗑
|
||||
| Medullary sponge kidney characteristics | Benign. Hereditary AD: MCKD1 or MCKD2 mutation on chromosomes 1 & 16. Dx in 4th-5th decade.
🗑
|
||||
| ADPKD genetics | Chromosome 16 short arm defect (90%). Chromosome 4 (10-15%), slower w/longer life expectancy
🗑
|
||||
| Epithelium-lined cavities filled with fluid or semisolid that develop from renal tubular elements = | cysts (70% of all renal masses)
🗑
|
||||
| Dx study for medullary sponge kidney | Intravenous pyelogram (IVP) - will show striations in papillary portions (=contrast accumulation in dilated collecting ducts)
🗑
|
||||
| Large echogenic kidneys on US = | ADPKD
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Abarnard
Popular Medical sets