Obstructive Uropathy/nephrolithiasis

4 causes of upper UTO

1. congenital narrowing

2. stone

3. polyps

4. malignancy

Describe the patho for upper urinary tract obstruction

increased hydrostatic pressure above level of obstruction is transmitted to glomerulus → low blood flow and GFR → damage kidney function

if unilateral, the other kidney compensate → hypertrophy of glomeruli

complication of upper UTO

loss of renal function → CKD

causes of urethral strictures

1. trauma: straddle injuries (from biking) or instrumentation (cath)

2. Post-infectious

3. Congenital

clinical manifestations of anatomic LUTO

(W FUN)

Weakened stream

Frequency

Urinary hesitancy

Nocturia

straining is part of what type of bladder dysfunction

underactive bladder (weak detrusor)

urolithiasis

stone in urinary system

whereas nephrolithiasis is specifically in kidney

Location of kidney stone and the symptoms

kidney parenchyma → no pain

Ureteropelvic junction → flank pain

Ureter → flank/abdomen/pelvic/groin pain or urgency/frequency

Bladder → no pain

what would you see on renal ultrasound for nephrolithiasis

shadowing

RBUS twinkle effect

sometimes can’t see stone but can see other signs of obstruction

• hydronephrosis

• no ureteral jet

foods high in purine

1. beef

2. poultry

3. pork

4. fish

5. asparagus

6. beans

7. lentils

8. spinach

high purine consumption associated with

uric acid stones and gout

patient on citrate therapy raises suspicions of what type of stone

calcium phosphate

colorless, flat, hexagonal crystal is what type

cystine

what type of stone is associated with lesch-nyhan syndrome

xanthine

which stone is associated w renal tubular acidosis

calcium phosphate

stones formed in alkaline urine

Calcium phosphate

Struvite

medical tx for nephrolithiasis

tamsulosin (flomax) - alpha blocker

what are two procedures to provide immediate relief to obstruction cause by nephorlithiasis

1. nephrostomy tube

2. ureteral stent

Which surgery is best for staghorn calculi

percutaneous nephrolithotomy

which surgical procedure is best for stone stuck in distal ureter

ureterscopy

which surgical procedure is beter for when stone is in pelvis of kidney

shock wave lithotripsy

what are the two radiolucent stones

uric acid and xanthine

what 3 stone types should push u towards completing a metabolic stone evaluation

1. cystine

2. uric acid

3. struvite

T or F: Nonpharm includes reducing concentration of stone components which includes decreasing calcium intake

FALSE!
Although its true that you should decrease concentration of stone components, calcium specifically should still be consumed in normal amounts because reductions can actually increase risk of kidney stones

risk factors of uric acid stone formation

1. low urine volume

2. low urine pH

3. Purine consumption

4. hyperuricosuria/Hyperuricemia

at what pH do uric acid stones form

pH <5.5

at what pH do infectious lithiasis form

pH >7.5 (struvite)