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What are the main risk factors for calcium oxalate stones
Higher urine calcium, higher urine oxalate, and lower urine citrate
How does urine pH affect calcium oxalate stone formation
It is insensitive to pH in the physiologic range
Why is dietary calcium restriction not recommended for calcium oxalate stone prevention
It can increase oxalate absorption and stone formation
What dietary approach significantly reduces calcium oxalate stone recurrence
A diet with 1200 mg calcium, low sodium, and low animal protein
How do thiazide diuretics help prevent calcium oxalate stones
They lower urine calcium excretion and reduce stone recurrence by ~50%
Why is dietary sodium restriction important when taking thiazide diuretics
To maximize calcium reduction and minimize potassium losses
Can bisphosphonates be used for calcium oxalate stone prevention
No, they reduce urine calcium but lack evidence for preventing stones
How can endogenous oxalate production be reduced
Avoiding high-dose vitamin C supplements
What foods should be limited to reduce oxalate absorption
Spinach, rhubarb, almonds, and potatoes
Why is extreme oxalate restriction not recommended
It may harm overall health and does not significantly reduce stone recurrence
How does calcium intake influence oxalate absorption
Higher calcium intake reduces oxalate absorption
What role does the intestinal microbiota play in oxalate metabolism
Oxalate-degrading bacteria may reduce oxalate absorption, but no long-term therapies exist
How can urine citrate levels be increased naturally
Higher intake of alkali-rich foods like fruits and vegetables
What is a medical option for increasing urinary citrate in low-citrate patients
Potassium citrate or bicarbonate supplements
Why are sodium-based alkali supplements usually avoided
They increase urine calcium excretion
What is the relationship between urine uric acid and calcium oxalate stones
No strong association, but allopurinol may reduce recurrence
How might dietary modifications help prevent calcium oxalate stones
Reducing nondairy animal protein and sodium intake
What dietary pattern is inversely associated with kidney stone formation
The DASH diet
What are the main risk factors for calcium phosphate stones
Higher urine calcium, lower urine citrate, higher urine phosphate, and urine pH ≥6.5
Which conditions are associated with calcium phosphate stones
Distal renal tubular acidosis and primary hyperparathyroidism
How can thiazide diuretics help prevent calcium phosphate stones
They reduce urine calcium excretion when combined with sodium restriction
Why must urine pH be monitored when giving alkali supplements to calcium phosphate stone formers
Alkali can raise urine pH and increase stone formation risk
How might dietary phosphate reduction help with calcium phosphate stones
It may lower urine phosphate excretion
What are the two main risk factors for uric acid stones
Persistently low urine pH and high uric acid excretion
What is the primary strategy for preventing uric acid stones
Increasing urine pH through dietary changes or alkalinizing agents
How can urine pH be increased naturally
Consuming more fruits and vegetables while reducing animal protein intake
What is the target urine pH for uric acid stone prevention
6.5 throughout the day and night
What is the relationship between purine intake and uric acid stones
Purines increase uric acid generation, contributing to stone formation
Why is serum uric acid level not a reliable indicator of urine uric acid excretion
It depends on the fractional excretion of uric acid, which can vary
What medications can lower urine uric acid excretion if alkalinization and diet fail
Xanthine oxidase inhibitors such as allopurinol or febuxostat
Why is long-term dietary cystine restriction not a viable strategy
It is not feasible and unlikely to be successful
What is the primary goal in preventing cystine stone formation
Increasing cystine solubility
Which medications bind to cystine to prevent stone formation
Tiopronin or penicillamine
Why is tiopronin preferred over penicillamine for cystine stone prevention
Tiopronin has a better adverse event profile
What is the recommended urine pH for cystine stone prevention
7.5
Why are sodium-based alkali supplements avoided for cystine stones
Sodium can increase cystine excretion
What is a crucial preventive measure for all stone types, especially cystine stones
Maintaining a high urine volume
What are struvite stones also known as
Infection stones or triple-phosphate stones
Which bacteria are commonly associated with struvite stones
Urease-producing bacteria such as Proteus mirabilis, Klebsiella pneumoniae, and Providencia species
How do urease-producing bacteria contribute to struvite stone formation
They hydrolyze urea, raising urine pH above 8.0
What is a common complication of struvite stones
They can grow rapidly and form staghorn calculi
What is the primary treatment for struvite stones
Complete removal by a urologist
How can new struvite stone formation be prevented
Preventing UTIs
Which medication can be considered for patients with recurrent upper UTIs to prevent struvite stones
Acetohydroxamic acid (urease inhibitor)
Why do preventive regimens for kidney stones need to be followed for a lifetime
They do not cure the underlying pathophysiologic process
Why is long-term follow-up important for kidney stone prevention
To ensure the preventive regimen is implemented and effective
What common patient behavior increases the risk of recurrent kidney stones
Returning to old habits such as insufficient fluid intake
Why are repeat 24-hour urine collections necessary in long-term follow-up
To confirm that risk factors for stone formation are being controlled
Why should follow-up imaging be planned thoughtfully for kidney stone patients
To minimize unnecessary radiation exposure while obtaining useful diagnostic information
What is a common issue with patients experiencing recurrent renal colic
Frequent emergency room visits often leading to repeat CT scans
Why should CT scans be used cautiously in long-term follow-up
They have a significantly higher radiation dose than other imaging modalities
What are the limitations of using KUB for follow-up imaging
Small stones may be missed
Why is ultrasound not always ideal for follow-up imaging of kidney stones
It has limited ability to determine stone size and number
What must be balanced when planning long-term follow-up imaging
Minimizing radiation exposure while obtaining necessary diagnostic information