Kidney stones

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  1. Women with recurrent UTI are at risk for what type of stone?
    Women with recurrent urinary tract infections with urease-splitting Klebsiella and Proteus species have an increased risk for struvite stones.
  2. Who is at increased risk of uric acid stone formation?
    Patients with hyperuricosuria, especially those with urine uric acid levels greater than 1000 mg/24 h (5.9 mmol/d), have an increased risk of uric acid stone formation.
  3. What size kidney stone frequently pass spontaneously with supportive treatment?
    Approximately 90% of kidney stones less than 5 mm in diameter pass spontaneously with supportive treatment.
  4. What is the gold standard for diagnosing kidney stone?
    Noncontrast helical abdominal CT is the gold standard for diagnosing kidney stones.
  5. What medications are indicated for pts with an acute attack of kidney stones?
    What medications can help increase the rate of spontaneous stone passage?
    In patients with an acute attack of kidney stones, NSAIDs or narcotic agents can be used to relieve pain and a calcium channel blocker or α-blockers may help to increase the rate of spontaneous stone passage.
  6. When is lithoripsy indicated in the treatment of kidney stones?
    Extracorporeal shock-wave lithotripsy is indicated for stones less than 1 cm in diameter located in the kidney and upper urinary tract.
  7. When is percutaneous nephrolithotomy indicated in the treatment of kidney stones?
    Percutaneous nephrolithotomy is indicated for stones larger than 1 cm in diameter, staghorn calculi, and cystine stones that are resistant to extracorporeal shock-wave lithotripsy and in patients with urinary tract abnormalities.
  8. When is ureteroscopy recommended in the treatment of kidney stones?
    Ureterorenoscopy is recommended to remove kidney stones in the distal ureter or to remove stone fragments caused by extracorporeal shock-wave lithotripsy.
  9. What is your intervention in pts with hyperoxaluria?
    In patients with hyperoxaluria, dietary calcium intake should be increased to 1 to 4 g daily. Foods high in oxalate such as rhubarb, peanuts, spinach, beets, and chocolate also should be avoided.
  10. What are your interventions in pts with cysteine stones?
    Cystine stones account for only 1% to 3% of all kidney stones. More than 50% of patients with these stones have cystinuria, an autosomal-recessive disorder that results in increased urine cystine excretion. Clues that suggest cystine stones include large branched calculi or kidney stones that occur in childhood or adolescence. In patients with cystinuria, urine alkalinization is indicated to increase the solubility of cystine. Penicillamine and captopril also should be used to decrease serum cystine levels.
  11. What is a recommended intervention in pts with calcium oxalate stones due to low citrate level?
    A decrease in citric acid, which binds to urine calcium and inhibits calcium oxalate stone formation, is another risk factor for calcium oxalate nephrolithiasis. Potassium citrate supplementation or intake of foods high in citrate such as lemon juice helps to decrease the risk of recurrent stones.
  12. What are management of choice for infected struvite stone?
    Antibiotic therapy and referral for stone removal are the management of choice for infected struvite stones.
  13. What interventions would you do in pts with uric acid stones?
    In individuals with gout and hyperuricosuria, urine alkalinization increases the solubility of uric acid and decreases the formation of kidney stones. Allopurinol also may be warranted in recurrent uric acid stone formers to decrease urine uric acid excretion if increased fluid intake and alkalinization of the urine fail to decrease the rate of uric acid stone formation. The hyperuricosuric effects of probenecid may exacerbate stone disease, and this agent should be avoided in patients with gout who have a history of uric acid stones.
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Kidney stones
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