SF: Chapter 26pt5

Renal Calculi affects how many people in the US throughout their lifetime?

1 in 11

what is the medical term for kidney stones

nephrolithiasis/urolithiasis

What are kidney stones

hard deposits that form inside the kidneys

What are kidney stones made of

minerals and salts

How are kidney stones formed

when urine minerals crystallize and stick together

Where can renal calculi occur

kidneys, ureter, urinary bladder

What is a common cause of kidney stones

urinary tract obstruction that causes urine concentration

How often is kidney stone recurrence

30-50% within 5 years

How to reduce the risk of kidney stones

proper water intake and staying physically active

Risk factors of kidney stones: gender

men

Risk factors of kidney stones: race

white>hispanics>black>asian

Risk factors of kidney stones: geography

warm, dry climates

Risk factors of kidney stones: other

dehydrated, diet, hx, obese, digestive disease, meds/vitamins

What kind of diet can put people at risk of kidney stones

high protein, sugar, and salt

What kind of digestive diseases/surgery can put people at risk of kidney stones

gastric bypass, IBD, diarrhea

What kind of medical condition can put people at risk of kidney stones

diabetes mellitus, HTN, metabolic syndrome, hyperparathyroidism, multiple UTI

What kind of medications/vitamins can put people at risk of kidney stones

VitC, excessive laxatives, calcium carbonates, migraine and depression meds

What alters type of kidney stone

minerals that comprise the stone or location and size

What is the most common type of kidney stone

Calcium oxalate or phosphate (70-80%)

Oxalate is made where

in liver or absorbed in diet

Where do we find oxalate in diet

fruits, veggies, nuts, chocolate

Phosphate comes from?

metabolic conditions and meds to treat migraines/seizures

Struvite kidney stones are composed of

Mg-Al-Phosphate

How common are struvite kidney stones

15%

How common are Uric acid kidney stones

7%

How common are cystine kidney stones

RARE, <1%

struvite kidney stones from in response to

UTI

Uric acid kidney stones come from?

chronic diarrhea, malabsorption, high protein, DM, metabolic syndrome, genetic factors

Cystine kidney stones come from?

hereditary condition where the kidneys excrete too much cystine amino acid

Staghorn calculi def.

complex stones that are very large

Where are staghorn calculi found

minor/major calyx and renal pelvis

What do staghorn calculi cause

high morbidity rates

What can happen if staghorn calculi go untreated

recurrent UTI, urosepsis, death

What is the gold standard for staghorn calculi

Percutaneous nephrolithotomy (PCNL)

How does PCNL work

pass a needle into the skin using an ultrasound, xrya, or CT to guide placement/ Then use a tube sheath along the needle to break up the stone and remove it

What may need to be placed during a PCNL

nephrostomy tube to drain urine out

How soon can a nephrostomy be removed after healing

4-6 weeks

If the body doesn't heals after a PCNL, what needs to happen

nephrectomy

What are symptoms of staghorn calculi

severe, sharp flank/back pain below the ribs that can radiate to the groin

When do symptoms occur with staghorn calculi

with stone movement in the kidney and as it enters the ureter

What happens if a stone becomes lodged?

blocks the flow of urine and the kidney swells and ureter spasms

What might also be noted as a symptom of kidney stones

hematuria and pain/burning when peeing, urge to pee with small yield, fever and chills

How does urine look with kidney stones

cloudy with pink, red, or brown urine

How do we diagnose kidney stones

hx, check blood work, urinalysis, and imaging

kidney stone history includes

diet habits, age of first stones, stone analysis, and complications associated with

What would blood work show with kidney stones present

elevated calcium or uric acid

what are we looking for in a urinalysis

calcium oxalate

what do we use imaging for with kidney stones

location of the stone and severity of the obstruction

what types of imaging do we use for kidney stone detection

ultrasound and ct

how do we retrieve kidney stones to analyze them

they're passed spontaneously or we do aggressive intervention (sieve urine)

Goals of treating kidney stones

manage acute pain, promote stone passage, reduce size of current stone, prevent new stone formation

how can we prevent new stone formation

adjust dietary intake and pH

how can we remove kidney stones

PCNL, ureteroscopy, ultrasonic/laser lithotripsy, ESWL to breakdown the stone size, PT gland surgery

Ways to prevent recurrence of kidney stones

increase fluid intake, avoid dark colored soft drinks, avoid dietary oxalate, eat less animal protein, limit sodium intake, maintain dietary calcium

how much dietary calcium should we consume a day

1000-1200 g

Overactive bladder def.

urinary urgency that presents as frequent peeing, incontinent, nocturia

What causes oab

idiopathic, NOT UTI

causes of oab

involuntary contraction of detrusor muscles, female, >65, excessive caffeine/alcohol intake, slow to get to bathroom

risk factors for oab: women

vaginal birth, episiotomy, pelvic organ prolapse surgery, decreased estrogen

risk factors for oab: men

enlarged prostate with urinary obstruction, surgery for prostate cancer

risk factors for oab: both

diuretics, antidepressants, analgesics, sedatives

Diagnosis of oab

detailed H&P, urinalysis, questionnaires to check severity, neuro exam, rectal/pelvic exam, check pot-void residual urine

1st line treatment for oab

behavioral therapy

1st line treatment for oab ex:

pelvic floor exercises, bladder training/timed voiding, management of fluid intake

2nd line treatment for oab

pharmacologic therapy

2nd line treatment for oab ex:

topical vaginal estrogen, drugs that increase urethral sphincter contraction

What happens if oab goes untreated

impairs quality of life, skin breakdown, sleep issues, falls, depression, nursing home admissions increase

cystitis def.

inflammation of the bladder due to bladder infection

the bladder is the most common site of?

UTI

what are the 2 most common infecting microorganisms for cystitis

e.coli and staph. saprophyticus

symptoms of cystitis

dysuria, frequency, urgency, suprapubic and low back pain

SERIOUS symptoms of cystitis

hematuria, cloudy urine, flank pain

ELDERLY symptoms of cystitis

asymptomatic bacteriuria; confusion, vague ab discomfort

causes of cystitis

sex and improper wiping

How to confirm dx of cystitis

urine dipstick test

how will uncomplicated cystitis present

positive leukocyte esterase or nitrile reductase

how will symptomatic cystitis present

urine culture positive. need to check abx sensitivity

how to treat uncomplicated cystitis

microorganism specific abx 3-7 days

how to treat complicated cystitis

abx 7-14 days. If there is a relapse in this time, need longer treatment

What to do after initial treatment of complicated cystitis

follow up urine culture

after the initial treatment of complicated cystitis, how often should we do follow up urine cultures

1 week after initial; 3x monthly; every 3-4 months for a year

acute pyelonephritis def.

infection of 1 or both upper urinary tracts (ureter, renal pelvis of kidney)

is acute pyelonephritis more common in men or women

women

symptoms of acute pyelonephritis

fever, chills, flank/groin pain, urinary frequency, dysuria, costovertebral tenderness before systemic pain

symptoms of acute pyelonephritis in the elderly

nonspecific presentations: low grade fever and malaise

causes of acute pyelonephritis

renal calculi, pregnant, female sexual trauma, instruments for medical procedures, neurogenic bladder

how to diagnose acute pyelonephritis

urine analysis, urine culture, WBC in urine

how to treat uncomplicated acute pyelonephritis

MO specific antibiotic for 2-3 weeks. follow up urine cultures at weeks 1 and 4 post treatment if symptoms reoccur

how to treat complicated acute pyelonephritis

blood cultures and urinary tract imaging

acute kidney injury def.

sudden decline in renal function with decrease in GFR and urinary output

acute kidney injury has an accumulation of?

nitrogenous waste in the blood

What are the causes of acute kidney injury

ischemic injury, toxic injury from chemicals, sepsis induced injury

how to diagnose acute kidney injury

need to know cause of disease. History of surgery, trauma, or CV disorder

3 classifications of acute kidney injury

prerenal, intrarenal, postrenal

acute kidney injury: prerenal def.

renal hypoperfusion

What causes acute kidney injury: prerenal

hemorrhage or fluid loss from burns

What classification is the most common reason for acute kidney injury

prerenal

acute kidney injury: intrarenal def.

disorder of renal parenchyma / interstitial tissue

What causes acute kidney injury: intrarenal

DIC, allograft rejection

acute kidney injury: postrenal def.

urinary tract obstructive disorders