Renolithiasis

Question 1

When there is increased calcium present within the kidney it can either lead to?

Answer 1

nephrocalcinosis or nephrolithiasis

Question 2

generalized calcification which can result from either of the two fundamental types of pathologic calcification: metastatic or dystrophic

Answer 2

Nephrocalcinosis

Question 3

Nephrocalcinosis can involve either the (1) or the (2)

Answer 3

1. tubules 2. interstitial area between tubular cells

Question 4

Nephrocalcinosis leads to the destruction of the tubular system, resulting in reduced (1), (2) (loss of sodium), or (3) (loss of bicarb or retention of acid as H+).

Answer 4

1. renal concentrating ability 2. salt wasting 3. renal tubular acidosis

Question 5

Metastatic calcification usually present when there is (1), caused by such disorders as (2), or (3) which increase calcium; or disorders that increase intestinal calcium absorption, like (4)

Answer 5

1. elevated serum calcium 2. primary hyperparathyroidism 3. osteolytic cancer metastasis 4. vitamin D overdose or sarcoidosis

Question 6

Nephrocalcinosis from metastatic calcification consists of wedge shaped scars which microscopically show calcification within (1) as well as the (2)

Answer 6

1. tubular basement membrane 2. interstitium

Question 7

Ultrastructurally (electron microscopy), the calcium is present within (1)

Answer 7

Nephrocalcinosis from metastatic calcification 1. mitochondria

Question 8

Dystrophic calcification is found in instances where there is (1), and calcification occurs as a result

Answer 8

1. injury or infection

Question 9

Nephrolithiasis often damage the (1) to cause (2)

Answer 9

1. transitional epithelium 2. hematuria (blood in the urinary tract)

Question 10

term that refers to intermittent pain

Answer 10

colic

Question 11

Nephrolithiasis can distend the ureter intermittently, causing ?

Answer 11

renal colic

Question 12

In some instances, the stone results from an elevated serum concentration of (1), which directly leads to increased urinary concentration of the insoluble crystals resulting in stone formation

Answer 12

uric acid or cysteine

Question 13

In the case of the most common type of stones, calcium stones, there is often (1) in the absence of (2)

Answer 13

hypercalcuria hyper-calcemia.

Question 14

Another type of calcium stone begins as a (1) stone, which is then surrounded by calcium precipitates as the stone is enlarging

Answer 14

uric acid

Question 15

(1) tend to be harder than calcium phosphate stones, and can injure the (2) as they form and pass into the ureter

Answer 15

1. Calcium oxalate stones 2. renal pelvis

Question 16

Although a bit counterintuitive, (1) can sometimes cause more symptoms because they can pass into the ureters causing pain

Answer 16

smaller stones

Question 17

Urea splitting bacteria (proteus or providencia) produce (1) stones which are also known as (2). These can be very large stones that form a cast of the (4) and are known as (3) because of their resemblance to deer antlers.

Answer 17

1. magnesium ammonium phosphate 2. struvite 3. staghorn calculi 4. renal pelvis

Question 18

Uric acid stones form in about one-fifth of patients with (1), but can also be found in patients with (2)

Answer 18

1. hyperuricemia (elevated serum uric acid) 2. normal serum uric acid but elevated uric acid in urine (hyperuricaciduria).

Question 19

Histologically, there can be yellow streaks as (1) form in the (2) and can lead to tophus formation with (3) surrounding the crystals

Answer 19

1. uric acid crystals 2. renal calyces and pelvis 3. macrophages

Question 20

There can also be obstruction of more proximal tubules leading into the calyces which can produce dilated tubules

Answer 20

Uric acid stones

Question 21

Disorders which produce elevated amounts of purines in blood such as the tumor lysis syndrome (when cancer patients have cancer cell lysis from chemotherapy) can lead to?

Answer 21

hyperuricaciduria and uric acid stones

Question 22

In addition, (1) intoxication due to exposure to metal alloys containing (1) leads to decreased uric acid urinary elimination which can elevate the concentration of uric acid in serum, urine, or both, leading to uric acid stones. This condition is called (2)

Answer 22

1. lead 2. saturnine gout

Question 23

Histologically there can be yellow streaks as the conditions responsible for stone formation include?

Answer 23

low urine flow, urine pH (some stones form more readily in more acidic and others in more alkaline urine), and super-saturation of the component which forms the crystal.

Question 24

A relatively common cause of renal stones in children is (1) which results from a mutation in (2)

Answer 24

1. cystinuria 2. the dibasic acid transporter

Question 25

Cystinuria also causes poor transport of other basic amino acids such as (1) but cysteine is the crystal that forms the stones

Answer 25

1. lysine and arginine

Question 26

Fanconi’s anemia has a number of abnormalities, including defects in the (1) that can lead to (2)

Answer 26

1. proximal tubule 2. renal tubular acidosis and formation of renal stones

Question 27

Dent’s disease can result from mutations in specific (1) which leads to increased (2) in urine and ultimately to formation of renal stones

Answer 27

1. chloride channels 2. calcium and phosphate

Question 28

Less than a quarter of stones occur as a consequence of infections within the (5)

Answer 28

5. renal pelvis or collecting ducts

Question 29

Nephrocalcinosis effects ____ & ____ causing destruction of the tubular system.

Answer 29

tubules and interstitial area between the tubular cells

Question 30

Clinical signs of nephrocalcinosis

Answer 30

cause tubular defects aka destruction of the tubular system resulting in: Impaired concentration ability (1st thing lost in renal disease), Salt wasting (loss of sodium) Renal tubular acidosis

Question 31

* Hypercalcemia (and thus METASTATIC) leading to nephrocalcinosis due to: * (1) * (2)

Answer 31

* (1) ↑resorption of calcium from bone (various causes) * (2) ↑Intestinal absorption of calcium (various causes)

Question 32

•Wedge-shaped scars mixed w/ relatively normal renal tissue.

Answer 32

Nephrocalcinosis gross

Question 33

EM--\> nephrocalcinosis, what do you see (be specific)

Answer 33

•MITOCHONDRIA of renal tubular epithelial cells contain abundant calcium deposits.

Question 34

Smaller stones are MOST HAZARDOUS; why?

Answer 34

•HAZARDOUS—b/c they pass into the ureters and produces colic.

Question 35

First clinical sign of larger stones

Answer 35

HEMATURIA

Question 36

Stones also predispose to \_\_\_; both by obstructive nature and by the trauma they produce

Answer 36

superimposed infection

Question 37

\_\_\_\_\_refers to stones in more downstream parts of the urinary system

Answer 37

Urolithiasis

Question 38

Treatment of kidney stones: 1 and 2

Answer 38

Ultrasonic disintegration (lithotripsy) and endoscopic removal

Question 39

•are hard and sharp --\> cause injury to the renal pelvis (so will see hematuria).

Answer 39

calcium oxalate

Question 40

Calcium oxalate stones (different lab changes) 1. Hypercalcemia AND hypercalciuria (RARE; 5%) 2. \_\_\_\_\_\_ •Most common; 55%; important to check urine!! 3. •Increased uric acid secretion--\> \_\_\_\_\_ 4. Hyperoxaluria

Answer 40

Hypercalciuria w/ NO hypercalcemia; MIXED URIC ACID & CALCIUM STONE

Question 41

why do you get mixed uric acid and calcium stone?

Answer 41

urate crystals act as nidus around which calcium salts precipitate

Question 42

\_\_\_\_\_--\>either hereditary (primary \_\_\_\_) or acquired by intestinal overabsorption in pts w/ GI diseases or on vegan diets

Answer 42

Hyperoxaluria

Question 43

•softer and paler due to DYSTROPHIC CALCIFICATION

Answer 43

•Calcium Phosphate Stones

Question 44

•Elevated serum uric acid due to: 1. 2. Hepatic catabolism of ____ released from ____ of necrotic cells (tumor lysis syndrome—seen with chemotherapy pts + myeloproliferative disorder). 3. Chronic lead intoxication

Answer 44

1. ↑production (gout), ↓excretion. 2. Hepatic catabolism of purines released from DNA of necrotic cells (tumor lysis syndrome—seen with chemotherapy pts + myeloproliferative disorder). 3. Chronic lead intoxication

Question 45

Chronic lead intoxication interferes w/ ____ by proximal tubules --\> uric acid accumulates producing \_\_\_\_

Answer 45

uric acid secretion; saturnine gout

Question 46

•Stones are smooth, hard, yellow and \<2cm. Uric acid stones are radiolucent

Answer 46

uric acid stone

Question 47

•Complication of uric acid: \_\_\_: uric acid crystal precipitation can obstruct the collecting ducts as a result of increased uric acid concentration in the acidic pH of urine

Answer 47

ARF (Acute Renal Failure)

Question 48

•Acute urate nephropathy: precipitated uric acid in the collecting ducts is seen grossly as \_\_\_\_. Tubules ____ to the obstruction are dilated

Answer 48

yellow streaks in the papillae; proximal

Question 49

* Histology of uric acid: * \_\_\_\_-\>a focal accumulation of urate crystals surrounded by inflammatory cells (macrophages) * Urate crystals in the adrenal medulla w/ ____ around them. \_\_\_\_ around the crystals (host response

Answer 49

Gouty tophus; giant cells; Fibrosis

Question 50

Xanthine Stones: XO deficiency/XO inhibitor (allopurinol and febuxostat

Answer 50

treatment for uric acid stones

Question 51

\_\_\_\_ stones represent a significant proportion of childhood calculi and occur w/ hereditary cystinuria

Answer 51

Cystine

Question 52

Cystinuria •Due to mutation in the ____ leads to decreased reabsorption of cystine and other dibasic amino acids (3 things).

Answer 52

dibasic acid transporter; lysine, ornithine, and arginine

Question 53

•Mutations in SLC 3A1 (recessive) Mutations in SLC7A9 (dominant)

Answer 53

Cystine stones

Question 54

Congenital mutations in chloride channels --\> present w/ kidney stones due to hypercalciuria, aminoaciduria, and phosphaturia

Answer 54

Dent's Syndrome

Question 55

Dent's--\> Congenital mutations in chloride channels; present w/ kidney stones due to \_\_, \_\_, and \_\_

Answer 55

hypercalciuria, aminoaciduria, and phosphaturia

Question 56

Has a number of abnormalities, including defects in energy and certain ion channels in the PROXIMAL TUBULE --\> that can lead to renal tubular acidosis and formation of renal stones

Answer 56

Fanconi's anemia

Question 57

Fanconi's: ## Footnote Has a number of abnormalities, including defects in energy and certain ion channels in the ___ --\> that can lead to ____ and formation of renal stones

Answer 57

PROXIMAL TUBULE; renal tubular acidosis

Question 58

Urinary loss of AMINO ACIDS, phosphate

Answer 58

Fanconi's anemia