FCP III: urolithiasis [disorders of urinary tract] (exam 6)

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MC type of urolithiasis
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What types kidney stones form in acidic urine?uric acidWhat types of kidney stone form in alkaline urine?MAPwhat type of kidney stones are associated with proteus UTIs?matrix stonesWhat types of kidney stones are radiolucent?- protease inhibitor stone - ammonium acid urate - matrix stone - uric acidWhat types of kidney stones are radiopaque?- calcium oxalate - MAPAre cystine stones radiolucent or radiopaque?radiolucent (per osmosis, Howie did not specify)Pt presents with kidney stones and you saw that he was taking indinavir for HIV. What is the most likely type of kidney stone?protease inhibitor stone (indinavir is a protease inhibitor drug!)Which kidney stone is radiolucent and also can't be seen on stone protocol CTprotease inhibitor stonewhich kidney stone is associated with UTIs and laxative abuse?ammonium acid uratePEx findings for nephrolithiasisfever hyperkinetic CVA tendernessPt presents to ED and you suspect they have urolithiasis. What imaging study do you order?CT stone protocol (abd/pelvis non contrast)indications for acute intervention for urolithiasis- obstruction - inability to take in PO due to severe N/V - severe pain not controlled with analgesicsHow can you acutely relieve obstruction caused by urolithiasisureteral stent or nephrostomy tube placementWhy should urolithiasis with obstruction be relieved ASAPto prevent sepsis and renal damage/loss of renal functionTreatment options for lower tract stones (bladder, urethra)- cystourethroscopy or cystolitholapaxy - ESWL - open stone removal - dissolutionStones that are ____ mm or less can undergo trial of passage for treatment (aka watchful waiting)5 mm or less (68% pass within 40 days)What medication is provided for pts undergoing trial of passage for urolithiasisalpha blocker (tamsulosin)How do you manage "trial of passage" treatment for urolithiasis- give alpha blocker - instruct pt to filter urine - periodic imaging to assess for hydronephrosisDissolution treatment for uric acid stonesraise urine pH over 6.5 by either taking sodium bicarb or potassium citrateHow long can dissolution treatment take to workup to 3 modissolution treatment for pts with cystine stonesraise pH over 7.5 by taking potassium citratedissolution treatment for struvite and calcium phosphate stonesirrigation with acidic solution (Renacidin)What does ESWL stand for?extracorporeal shock wave lithotripsypros of ESWL- outpatient, non-invasive - pt is sedatedcons of ESWLstone fragments are not removedabsolute contraindications for ESWL- prego - coagulopathy - UTI - renal artery aneurysm or triple ATreatment with ESWL is typically not recommended for pts with what types of stones?cystine or matrix stonerelative contraindications for ESWL- cystine or matrix stone - pancreatitis/pancreatic calcification - distal obstructionFor ESWL, kidney stones should be less than ____ cm and visible on fluoroscopy2 cmHow long may a pt experience decreased renal perfusion or function s/p ESWL?up to 3 wksWhat is percutaneous nephrolithotomy (PCNL)removal of stones via a tract passing through flank to kidneyindications for percutaneous nephrolithotomylarge stone burden (>2 cm) staghorn calculicontraindications of percutaneous nephrolithotomyUTI coagulopathy no percutaneous renal accesspneumothorax or hydrothorax is a complication for what kidney stone procedure?percutaneous nephrolithotomyWhat can reduce potential renal acid load (PRAL)- decrease animal protein intake (i.e. cheese and egg yolks) - eat fruits and veggiesgeneral diet for urolithiasis prevention- increase fluid intake - low sodium - reduce PRALpotassium citrate corrects acidosis/alkalosis, which decreases/increases urinary citrate and increases/decreases urinary calciumcorrects (acidosis); increases (urinary citrate); decreases (urinary calcium)side effects of potassium citratehyperkalemia and peptic ulcerspotassium citrate should be used with caution in...uncontrolled DM, renal insuff, gastroparesis, and K sparing diuretics (like spironolactone)thiazide diuretics correct acidosis/alkalosisacidosisWhat does allopurinol do and when should a pt receive this tx for kidney stones?reduces uric acid levels, only use if pt is hyperuricosuricpyridoxine deficiency leads to...hyperoxaluria → calcium oxalate stonesFor what type of kidney stone can pyridoxine (B6) given for to prevent further stones?calcium oxalateFor what type of stone can cholestyramine be given for to prevent further stone formation?calcium oxalateHow can cholestyramine prevent calcium oxalate stones?decreases colon wall permeability to oxalateWhat can D-penicillamine and Tiopronin be used for?cystinuria → prevent cystine stones