Nephrolithiasis - Kidney Stones

Calcium oxalate and phosphate

What is the most common form of kidney stone?

A. Calcium oxalate and phosphate

B. Uric acid

C. Struvite

D. Cystine

Imbalance

Nephrolithiasis is caused by an _______ of promoters and inhibitors of crystallization

Citrate, Magnesium

Inhibitors such as ______, _______, pyrophosphate, and uromodulin decrease in stone formation

Calcium, Oxalate

Promoters such as ______, ______, phosphate, irate, and cystine increase in stone formation

Malabsorption

Conditions, such as Crohn's disease or gastric bypass surgery, that affect gastrointestinal ________ are risk factors that may increase the risk of developing kidney stones.

Type II diabetes

Hyperparathyroidism, distal renal tubular acidosis, obesity, and _______ are all conditions that may increase the likelihood of developing kidney stones.

Calcium

Low dietary _____ intake may increase the likelihood of developing kidneys stoned because it decreases the absorption of oxalate. However supplemental ______ may increase the risk of developing kidney stones because it increases urinary _____ levels.

Fluid

Low ______ intake may increase the likelihood of developing kidney stones because not enough _______ reaches the kidney to be able to dilute and break up the formation of these stones.

Protein

High animal ______ intake may increase the likelihood of developing kidney stones because it can increase the excretion of calcium and uric acid while decreasing levels of citrate, which is essential for the prevention of kidney stone formation.

Vitamin C

High _________ intake in the form of supplements may increase the likelihood of developing kidney stones because they will increase levels of calcium oxalate in the urine.

Sodium

High ______ and sucrose intake may increase the likelihood of developing kidney stones because it increases the levels of these electrolytes in the urine.

Hot

Weight gain, ______ climate, or ______ environments, which may cause the patient to be dehydrated, are nondietary risk factors that may increase the patient's risk of developing kidney stones.

calcium

Low urine volume, lower urinary citrate, or higher urine levels of _______ and uric acid may increase the risk of developing kidney stones.

Loop diuretic

Furosemide, which is a _______, is a medication that may increase the risk of inducing kidney stones because of its mechanism of action. This drug is going to increase urinary calcium levels and this will increase the risk of forming kidney stones that are comprised of calcium oxalate or calcium phosphate.

Acetazolamide

_______, which is a carbonic anhydrase diuretic, is a medication that may increase the risk of inducing kidney stones because it is going to reduce urinary citrate and increase urinary calcium. This class of medication may also raise the pH of the urine, which creates an environment that is more favorable for kidney stone formation.

Topiramate

______, which is an anti-epileptic, is the only medication of this drug class to potentially induce kidney stone formation because it weakly inhibits carbonic anhydrase. Many other medications of this drug class have different mechanisms of action.

Ciprofloxacin

_______, which is a fluoroquinolone antibiotic, has a potential for inducing kidney stones because it has some action and excretion from the kidneys.

Sulfa

Bactrim, which is a ______ antibiotic, has a potential for inducing kidney stone formation because it has some action and excretion effect on the kidneys.

Integrase inhibitor antiretroviral

Raltegravir, which is an ___________, is a class of medications that has the potential to induce the formation of kidney stones.

Antiviral

Acyclovir, which is an ________, is a class of medications that has the potential to induce the formation of kidney stones.

Unilateral

Kidney stones may clinically present as a misnomer, varying levels of pain, have nausea and vomiting associated, and have a sudden onset of _______ flank pain that radiates to the abdomen or groin.

CT scan

What is the gold standard for diagnosing kidney stones?

CKD

Complications from kidney stones include pyonephrosis, hydronephrosis, and increased risk of _____

2.5-3

A nonpharmacological treatment for kidney stones is to increase fluid intake to at least ________ liters per day with the goal to produce at least 2.5 liters of urine per day.

1000-1200

A nonpharmacological treatment is to increase dietary calcium to ________ mg per day. It must be dietary calcium because supplemental calcium will increase the risk of developing kidney stones because more calcium would be available in the urine.

Citrate

A nonpharmacological treatment for kidney stones is to increase the intake of fruits and vegetables because it will increase the amount of ________ available in the urine. This compound is essential for preventing kidney stones.

Sodium intake (< 2.5 mg/day)

Other non-pharmacological treatments for kidney stones include avoiding high dose vitamin C, decrease ______, limiting animal protein, sucrose, fructose intake, and adapting a mediterranean/DASH diet.

Prostaglandins

Ketorolac works by reversely inhibiting COX1 and COX2 enzymes. This results in the decreased production of ________ and results in an analgesic and anti-inflammatory effect.

NSAIDs (Ketorolac)

What is the first line therapy for pain management of kidney stones?

5 days

What is the max duration of time that a patient can use Ketorolac?

30 mg

What is the IV dose of Ketorolac every 4 hours for a patient that weighs 55kg and is 60 years old?

120 mg

What is the max daily dose of Ketorolac for patients that weigh greater than or equal to 50 kg and is less than 65 years of age?

60 mg

What is the max daily dose of Ketorolac for patients that weigh less than 50 kg or is older than 65 years of age?

15 mg

What is the IV dose of Ketorolac every 4 hours for patients that weigh less than 50kg or is greater than 65 years of age?

Opioids

What is the second line option for pain control in kidney stones?

Alpha 1

Tamsulosin works as an expulsive therapy because it blocks the _______ receptors in the bladder and this results in the relaxation of the bladder and prostate, which can improve urine flow.

Tamsulosin

What medication is the first line therapy of medical expulsive therapy of kidney stones?

Lithotripsy

This is a noninvasive expulsive therapy of kidney stones where shock waves vibrate the kidney stone to break it up into smaller pieces so that the patient can pass the stone naturally.

Distal convoluted tubule

Thiazide diuretics are maintenance medications because they work on the _______ where it decreases urinary calcium by increasing the reabsorption of calcium back into the blood. This can help prevent the occurrence of another kidney stone.

Potassium citrate

This medication is a maintenance medication because it is an alkalinizing agent while increasing the amount citrate that is available in the urine.

Allopurinol

This medication is a maintenance medication that works by inhibiting xanthine oxidase and reducing uric acid production