Stones

Question 0

nephrolithiasis

Answer 0

stone in upper UT or collecting system

Question 1

calculus

Answer 1

concretion anywhere in the system

Question 2

bladder stones

Answer 2

stones in bladder

MC in underdeveloped countries

Question 3

nephrocalcinosis

Answer 3

calcification with renal parenchyma

rare, rarely cortex, uncommon

Question 4

5 major types of stones

Answer 4

calcium oxalate 
calcium phosphate 
uric acid
cystine
struvite

Question 5

calcium oxalate monohydrate

Answer 5

whewellitte

Question 6

calcium oxlate dihydrate

Answer 6

weddellite

Question 7

struvite

Answer 7

urease stones
infection stones
triple phosphate stones
magnesium ammonium phosphate

Question 8

supersaturation

Answer 8

ratio of salt/solubility
ss1 crystals
*can be changed by increase or decrease in urine volume

Question 9

stones result from

Answer 9

phase change (dissolve salt–>ppt)

Question 10

free particle model

Answer 10

crystal nuclei occur because increase in super saturation in dissolved salts present in ultrafiltrate (colelcting duct)

Question 11

fixed particle model

Answer 11

crystal nuclei form in lumen of nephron and adhere to tubular epithelial (requires renal cell injury)

jux of CD and papilla

Question 12

randall’s plaque hypothesis

Answer 12

loss of normal urothelial covering of renal papilla exposes a randall’s plaque (nidus of interstital CaPo4) that urine crystals can attach and grow on

Question 13

CaOx stone disease and antibitoics

Answer 13

oxalobacter formigenes uses oxalate to make ATP

if these bacteria decrease by antibiotics, oxalate will increase, risk of stones increases

Question 14

oxalates

Answer 14

coffee
tea
nuts
rhubarb
strawberries
cranberry juice

Question 15

metabolic defects taht could lead to CaOx stones

Answer 15

hypercalciuria
hyperoxaluria
hyperuricosuria
inhibitor deficiency

Question 16

how do you get hyperoxaluria?

Answer 16

increase in production (congenital, too much vit C, glycol)

OR decrease Ca to bind due to malabsorption–>too much oxalate absorbed through intestine

Question 17

treatmetn of hyperoxaluria

Answer 17

ca or mg supplemetation + treating malabsorption

Question 18

uric acid crystals and hyperuricosuria

Answer 18

uric acid cyrystals may form nucleus for caox salt ppt–> treat with thiazide and allopurinol

Question 19

how do you get excess uric acid?

Answer 19

increase in purne–>increase uric acid–>bone buffering along with excess Ca–>crystals

increase purine from meat, gout, post chemo, lesch-nyans

Question 20

different inhibitor deficiencys

Answer 20

cirtate- complexes with Ca to dissolve (lost in chronic acidosis-RTA 1, CRG, acetazolamide)
Mg- forms sol complex with Ox
oral orthiphosphate-decreases Ca excretion
inorganic pyrophosphate

Question 21

CaPO4 stone risk factors

Answer 21

hypercalciuria

alkaline urine

Question 22

uric acid calculi are the

Answer 22

only truly radiolucent stones

Question 23

tx uric acid cyrstals

Answer 23

k+ cirtate (urine alklakinization)

Question 24

cystne stones

Answer 24

cystinuria due to an AR disease involving defect in 5 dibasic amino acids (COLA) transport in nephron and gastric mucosa, but only increase cysteine causes clinical manifestations

Question 25

Clinical cysteine stones

Answer 25

children mildly radio-opague staghorn nuclei-hexagonal crystals renal parenchymal dmaage

Question 26

tx cysteine stones

Answer 26

d-penicilamine-disrupts disulfide bonds in cystine

Question 27

struvite stones are main cause of

Answer 27

staghorn stones

Question 28

struvite stones are the MCC of

Answer 28

stones in women and paraplegics

Question 29

struvite stones form from

Answer 29

supersaturation with Mg-ammonium PO4

Question 30

patho of struvite stone

Answer 30

form in presence of UTI with a urea-splitting organism proteus, kleb, serratia, enterobacter bacteria resides in stone and cause srecurrent UTI

Question 31

marker of struvite stones

Answer 31

alkaline urine (7.5-8)

Question 32

dx of struvite stones

Answer 32

stone analysis, cystine crystalluria (hexagons), cyanide nitroprusside test (qualitative), 24hr urine studies (quant)

Question 33

clinical for struvite stones

Answer 33

staghorn nuclei recurrent uti progressive renal insuffiency, urospesis, peripnephric abscess, obstruction

Question 34

intervene for stone with

Answer 34

uncontrollable pain fever 1 kidney

Question 35

treatment for idiopathic hypercalcuria

Answer 35

hydrate, thiazides, diet that restricts Na, Ca, animal protein

Question 36

treatment of hyperuicosuria

Answer 36

allopurinol

Question 37

struvite treatment

Answer 37

antibiotics and urease inhibitors

Question 38

cystine treatment

Answer 38

hydrate, alkalinize, restrict Na, use d-pen to block sulfide bonds