Renal Definitions/terms to know for Renal test 2

Kidney Stone definition

A stone (hard pebble) that develops from crystals that form in urine and build up on the inner surfaces of the kidney

Number 1 way to prevent kidney stone

increased hydration

Ways amount of urine production is affected

• Amounts of liquid and types of food a person consumes

• Amount of fluid lost through sweating and breathing

• Certain medication, medical conditions, and types of food/drink

• Consumption of Alcohol and caffine

3 types of kidney stones

• Crystal nephropathy

• Acute uric acid nephropathy

• Drug-induced crystal nephropathy

Medication that increases risk of kidney stones

• Sulfadiazine

• Acyclovir

• Triamterene

• Methotrexate

Nucleation definition

Solid crystal nidus forms from precipitated solute

Ways of kidney stone removal

• Endoscopic Renal Stone Removal

• Shock wave lithotripsy (most common)

Pharmacological therapy for Kidney stones passing

• Pain relievers

• Alpha blockers

Types of kidney stones

• Calcium oxalate stones

• Calcium phosphate

• Uric Acid stones

• Struvite stones

• Cystine stones

Calcium oxalate stones characteristics

More likely to form in Acidic Urine

• Black/Dark brown

• Show up on X-rays

Calcium oxalate formation

• genetic defect that increase oxalate in urine

• defects in liver that leads to increase in oxalate in urine

• Diet heavy in oxalate rich food

what are some oxalate rich foods

• chocolate

• Nuts

• Beer

Calcium phosphate stones characteristics

More likely to form in alkaline urine

• Grungy white in color

• show up in X-ray

Factors from both Calcium-based stones 

impaired renal tubular reabsorption of calcium can increase calcium levels in urine and promote stone formation

• also can be affect by PTH levels

Uric acid stones characteristics

Weak acid that at physiologic pH forms monosodium salt of urate ion

• Red/brown color

• Does not show up on X-ray

Uric acid crystals can seed the formation of calcium oxalate stones

Uric acid stones formation

• Low urine output

• high protein diet

• other risk factors that lead to build up of Uric acid

Uric acid stones prevention

Urinary alkalization with potassium citrate or sodium bicarbonate

Medication used to decrease uric acid

Allopurinol

Allopurinol MOA

Blocks xanthine oxidase and therefore blocks production of uric acid in the liver

Struvite stones characteristics

Infection stones

• Grungy and white

• Shows on X-ray

Struvite definition

phosphate mineral

Struvite stones Formation

ammonia is present with bacteria

• bacteria converts urea to carbon and ammonia

• Ammonia makes urine more alkaline

Cystine stones formation

inadequate reabsorption of cystine in the proximal convoluted tubules resulting in excessive concentration of amino acids in urine

• Formed under normal physiological conditions

Cystine kidney stones characteristics

• cysteine level is above 250 mg/L

• caused by mutation of SLC3A1 and SLC7A9

• Ages 10-30

• Worse in Males

Magnesium prevention of kidney stones 

forms highly soluble sales with oxalate and phosphate

Citrate prevention of kidney stones 

Tighter binding to calcium than mono-cations. Reduced amount of calcium available to bind to oxalate or phophate

Dent disease

Rare X-linked recessive inherited condition resulting in excess calcium in the urine

Hereditary distal renal tubular acidosis (metabolic acidosis)

inability to secrete H+ ions, resulting in failure to excrete ammonium

• leads to excess of Ca+ in urine

Hypercalciuria

large amount of Ca in the urine

Bartter syndrome types III and IV

Mutation of various genes encoding proteins that transport ions across renal cells

• leads to Ca in urine 

Autosomal dominant hypocalcemic hypercalciuria

Mutation of CASR gene

• increase Ca+ in urine

Hypocitraturia

genetic defect that leads to too little citrate in urine

Primary hyperoxaluria

A mutation that results in the production of high amounts of oxalate in the body

• leads to increased oxalate in urine

Cystinuria

Genetic defect in a reabsorption transporter in the kidney 

• Leads to increase in cystine stones 

Diet and lifestyle changes of calcium oxalate and calcium phosphate stones

• increase fluid intake

• increase citrus consumption

• maintain citrate and magnesium intake

• Moderate calcium consumption

Decrease

• Decrease Na+, Animal proteins, Oxalate foods

Pharmacotherapy with Calcium containing stones

• reduce stone formation

• Fewer episodes of stone passage

• Reduce need for surgery

Medication to prevents cystine stones

Tiopronin

Tiopronin MOA

Thiola-cysteine dimer is more water soluble than the cysteine-cysteine dimer

Potassium citrate MOA

produces alkaline load and increased pH and raises urinary citrate

• leads to reduction of urinary Ca

Citrate tablets ER pt education notes

oral wax-matrix

• leads to ghost stools

Average Urine pH

6.2

Molecules reabsorbed in proximal tubule

Glucose

Amino Acids

Uric acid

Inorganic salts