Endo-Renal-L04-(D)-Stone Types and Long Term Follow Up

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54 Terms

1
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What are the main risk factors for calcium oxalate stones

Higher urine calcium, higher urine oxalate, and lower urine citrate

2
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How does urine pH affect calcium oxalate stone formation

It is insensitive to pH in the physiologic range

3
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Why is dietary calcium restriction not recommended for calcium oxalate stone prevention

It can increase oxalate absorption and stone formation

4
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What dietary approach significantly reduces calcium oxalate stone recurrence

A diet with 1200 mg calcium, low sodium, and low animal protein

5
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How do thiazide diuretics help prevent calcium oxalate stones

They lower urine calcium excretion and reduce stone recurrence by ~50%

6
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Why is dietary sodium restriction important when taking thiazide diuretics

To maximize calcium reduction and minimize potassium losses

7
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Can bisphosphonates be used for calcium oxalate stone prevention

No, they reduce urine calcium but lack evidence for preventing stones

8
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How can endogenous oxalate production be reduced

Avoiding high-dose vitamin C supplements

9
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What foods should be limited to reduce oxalate absorption

Spinach, rhubarb, almonds, and potatoes

10
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Why is extreme oxalate restriction not recommended

It may harm overall health and does not significantly reduce stone recurrence

11
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How does calcium intake influence oxalate absorption

Higher calcium intake reduces oxalate absorption

12
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What role does the intestinal microbiota play in oxalate metabolism

Oxalate-degrading bacteria may reduce oxalate absorption, but no long-term therapies exist

13
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How can urine citrate levels be increased naturally

Higher intake of alkali-rich foods like fruits and vegetables

14
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What is a medical option for increasing urinary citrate in low-citrate patients

Potassium citrate or bicarbonate supplements

15
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Why are sodium-based alkali supplements usually avoided

They increase urine calcium excretion

16
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What is the relationship between urine uric acid and calcium oxalate stones

No strong association, but allopurinol may reduce recurrence

17
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How might dietary modifications help prevent calcium oxalate stones

Reducing nondairy animal protein and sodium intake

18
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What dietary pattern is inversely associated with kidney stone formation

The DASH diet

19
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What are the main risk factors for calcium phosphate stones

Higher urine calcium, lower urine citrate, higher urine phosphate, and urine pH ≥6.5

20
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Which conditions are associated with calcium phosphate stones

Distal renal tubular acidosis and primary hyperparathyroidism

21
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How can thiazide diuretics help prevent calcium phosphate stones

They reduce urine calcium excretion when combined with sodium restriction

22
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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

23
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How might dietary phosphate reduction help with calcium phosphate stones

It may lower urine phosphate excretion

24
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What are the two main risk factors for uric acid stones

Persistently low urine pH and high uric acid excretion

25
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What is the primary strategy for preventing uric acid stones

Increasing urine pH through dietary changes or alkalinizing agents

26
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How can urine pH be increased naturally

Consuming more fruits and vegetables while reducing animal protein intake

27
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What is the target urine pH for uric acid stone prevention

6.5 throughout the day and night

28
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What is the relationship between purine intake and uric acid stones

Purines increase uric acid generation, contributing to stone formation

29
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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

30
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What medications can lower urine uric acid excretion if alkalinization and diet fail

Xanthine oxidase inhibitors such as allopurinol or febuxostat

31
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Why is long-term dietary cystine restriction not a viable strategy

It is not feasible and unlikely to be successful

32
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What is the primary goal in preventing cystine stone formation

Increasing cystine solubility

33
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Which medications bind to cystine to prevent stone formation

Tiopronin or penicillamine

34
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Why is tiopronin preferred over penicillamine for cystine stone prevention

Tiopronin has a better adverse event profile

35
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What is the recommended urine pH for cystine stone prevention

7.5

36
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Why are sodium-based alkali supplements avoided for cystine stones

Sodium can increase cystine excretion

37
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What is a crucial preventive measure for all stone types, especially cystine stones

Maintaining a high urine volume

38
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What are struvite stones also known as

Infection stones or triple-phosphate stones

39
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Which bacteria are commonly associated with struvite stones

Urease-producing bacteria such as Proteus mirabilis, Klebsiella pneumoniae, and Providencia species

40
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How do urease-producing bacteria contribute to struvite stone formation

They hydrolyze urea, raising urine pH above 8.0

41
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What is a common complication of struvite stones

They can grow rapidly and form staghorn calculi

42
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What is the primary treatment for struvite stones

Complete removal by a urologist

43
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How can new struvite stone formation be prevented

Preventing UTIs

44
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Which medication can be considered for patients with recurrent upper UTIs to prevent struvite stones

Acetohydroxamic acid (urease inhibitor)

45
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Why do preventive regimens for kidney stones need to be followed for a lifetime

They do not cure the underlying pathophysiologic process

46
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Why is long-term follow-up important for kidney stone prevention

To ensure the preventive regimen is implemented and effective

47
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What common patient behavior increases the risk of recurrent kidney stones

Returning to old habits such as insufficient fluid intake

48
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Why are repeat 24-hour urine collections necessary in long-term follow-up

To confirm that risk factors for stone formation are being controlled

49
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Why should follow-up imaging be planned thoughtfully for kidney stone patients

To minimize unnecessary radiation exposure while obtaining useful diagnostic information

50
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What is a common issue with patients experiencing recurrent renal colic

Frequent emergency room visits often leading to repeat CT scans

51
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Why should CT scans be used cautiously in long-term follow-up

They have a significantly higher radiation dose than other imaging modalities

52
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What are the limitations of using KUB for follow-up imaging

Small stones may be missed

53
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Why is ultrasound not always ideal for follow-up imaging of kidney stones

It has limited ability to determine stone size and number

54
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What must be balanced when planning long-term follow-up imaging

Minimizing radiation exposure while obtaining necessary diagnostic information