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5 Cards in this Set
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Nephrolithiasis
stone composition |
Calcium Oxalate (75%)
monohydrate--dumbbell shape dihydrate--bipyramids Magnesium Ammonium Phosphate (Struvite)coffin lid shape --associated with infection w/ urea-splitting bacteria (proteus), often form large staghorn calculi Uric acid stones (powdery) --gout, leukemia & pt w/ acidic urine & Chrohn pt's Cystine Stones (hexagonal) Cystine & struvite stones are always abnormal & require further inversigation |
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Etiology of Calcium Oxalate Nephrolithiasis
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Idiopathic renal hypercalciuria--tx w/ Thiazide
Increased Ca2+ absorption-- excess vitamin D, Sarcoid or granulomatous disease Familial Hyperparathyroidism Multiple Myeloma--mets to bone |
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Presentation of Neprolithiasis
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Backache radiating into abdomen--may migrate towards lower abdomen. Hematuria
Nausea,diaphoresis, vomiting & anorexia. Pain unrelieved by positional changes |
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Drugs associated with calculi
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antacids w/ silica--silicate stones
Triamterene--calculi Carbonic Anhydrase Inhibitors--calculi Acyclovir--crystalluria-- calculi Antineoplastic drugs |
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Radiologic Studies for Stones
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KUB (kidney urether bladder) films--85% of stones have calcium and can be seen w/ KUB
Ultrasound--operator dependent- useful when KUB + IVP (intravenous pyelogram) "gold standard" retrograde pyelogram--for small radiolucent stones CT-seldom used (slice may miss it) MRI--not used |
