Weekly Recap Vol 5.

Nephrolithiaisis

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Chapter 312: Nephrolithiasis

Nephrolithiasis or Kidney Stones

- may form due to crystallization of lithogenic factors in the upper urinary tract

-  Stones may move into the ureter and may cause renal colic

- The importance of the identification of the type of urinary stone include:

• Prognostication

• Selection of optimal preventive regimen

• Treatment

The types of kidney stones include:

• Calcium oxalate: 75% most common

• Calcium phosphate: 15%

• Uric acid: 8%

• Struvite: 1%

• Cystine: <1%

  Many stones are:

• A mixture of crystal types (calcium oxalate and calcium phosphate)

• May contain protein in the stone matrix

• May be composed of medications (acyclovir, atazanavir, triamterene)

Pathogenesis of Nephrolithiasis:

Supersaturation

-This is the point at which the concentration product exceeds the solubility product.

-Presence of inhibitors of crystallization prevents the majority of the population from forming stones

Urine Citrate

• is the most clinically important inhibitor of calcium-containing stone

Indications of urologic intervention for kidney stones

• Evidence of UTI

• Stone measuring >6mm

• Anatomic abnormality (which decreases the probability of spontaneous passage)

• Intractable pain

Urologic Interventions Include:

1. Ureteral stent
   - May be placed cystoscopically
   - Process requires general anesthesia
   - May cause gross hematuria and increases the risk of UTI

2. Extracorporeal shockwave lithotripsy (ESWL)

   -Least invasive option
   - Uses shockwave generated outside the body to fragment the stone

3. Endourologic approach
   - Can remove a stone by basket extraction or laser fragmentation

4. Percutaneous nephrostolithotomy
   -Is indicated for large upper- tract stone

   -Renders the patient stone-free

Types of Stone that develop at a certain pH

• Uric Acid: pH less than or equal to 5.5

• Calcium Phosphate: pH greater than or equal to 6.5

• Calcium Oxalate: is not influenced by urine pH

Now Let’s Dive into the PUSH Trial

Stay Tuned For Next Week’s Topic

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