Urinary

Question 1

what is calculi in the urinary tract called

Answer 1

urolithiasis

Question 2

what is calculi in the kidneys called

Answer 2

nephrolithiasis

Question 3

for nephrolithiasis and urolithiasis when do stones form

Answer 3

Stones are formed when there is increase amount of urinary substances like calcium, oxalate, calcium phosphate, struvite (magnesium, phosphate) and uric acid

Question 4

factors that favor stone formation

Answer 4

1. Infection; urinary stasis; periods of immobility (ALL Ca goes to blood = when filtered, it creates stones)
2. Increased calcium concentration in the blood and urine
   = promote calcium precipitation (80% of all kidney stones are calcium-based)
3. Uric acid stone- seen in patients with gout and myeloproliferative disorders (leukemia)
4. Struvite- form in persistently alkaline ammonia-rich urine (seen in persistent UTI, neurogenic bladder)
5. Urine pH change; excessive concentration of solutes; family history; obesity; diet

Question 5

s/s of stones

Answer 5

• s/s depend on the presence of obstruction, infection, and edema
  1. Obstruction = blocks flow of urine = distends renal pelvis and proximal area of the obstruction

2. Some stones cause few symptoms (while slowly destroying the nephrons)
3. Stones in renal pelvis: intense deep ache in the costovertebral region (next slides); hematuria (WBC in urine); pyuria (reddish urine)
   - –>Pain radiates anteriorly and downward the bladder and toward the testes
   - –>Renal colic: pain suddenly becomes acute, with tenderness over the costovertebral area with nausea and vomiting.
4. Stone lodged in the ureter: acute excruciating colicky, wave-like pain = can radiate to the thigh and to the genitalia (ureteral colic)

Question 6

diagnostics of stones

Answer 6

1. CT scan
2. Blood chemistry and 24-hour urine collection
3. Patient history- family, diet, medication history

Question 7

types of stones

Answer 7

1. Calcium or oxylate
   - Due to increased absorption of calcium, hyperparathyroidism, dietary excess
   = limit foods high in oxylate: spinach, strawberries, rhubarb, chocolate, tea, and peanuts
2. Struvite (magnesium-ammonium-phosphate)
   - Caused by urate-producing bacteria
   - Associated with frequent UTI
   = prevent UTI’s if possible, make urine acidic; eat acid ash diet (foods w/ low pH) like vitamin C tablets
3. Uric acid
   - Urine pH lower than 5.5 = increase urate salt formation
   - Also common causes: family history, and rapid & dramatic weight loss
   = better for ppl with gout to have basic pH urine; eat alkaline ash diet (foods w/ high pH) like citrus fruits

treatment of uric acid stones:

• allopurinol (drug) lowers the serum uric acid level
• limit these foods: shellfish, anchovies, asparagus, mushrooms, organ meats

Question 8

in general treatment of all stones

Answer 8

increase fluid intake!!