Adam Shared "Kidney Stones " - 4 Picmonics

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Kidney Stones

Kidney Stones Ammonium Magnesium Phosphate
Precipitates with increased pH
Radiopaque on X ray and CT
Coffin lid crystal (pictured)
Also known as struvite
Account for 15% of stones (second most common)
Caused by infection with urease ⊕ bugs (eg, Proteus mirabilis, Staphylococcus saprophyticus, Klebsiella) that hydrolyze urea to ammonia causing increasedŽ urine alkalinization
Commonly form staghorn calculi (of calyces, pictured); can act as nidus for UTI
Treatment: eradication of underlying infection, surgical removal of stone
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Kidney Stones Uric Acid
Precipitates with decreased pH
RadiolUcent (Urea) on X ray and barely visible on CT; Visible on ultrasound
Rhomboid (pictured) or rosettes shaped crystals
About 5% of all stones (third most common)
Risk factors: decreased urine volume, hot arid climates, acidic pH
Strong association with hyperuricemia (eg, gout)
Often seen in diseases with increased cell turnover, such as leukemia and myeloproliferative disorders
Other causes: Metabolic syndrome and chronic diarrhea
Treatment: hydration, alkalinization of urine (potassium carbonate), allopurinol (gout patients)
Usually precipitates in the distal tubules and collecting ducts due to low pH
U. Chronic diarrhea (or post colectomy) have reduced bicarbonate absorption in the gut, kidney compensate with H+ excretion --> low pH
Needle-shaped crystals on urinalysis indicate uric acid stones
Have to be evaluated by CT (non contrast) of the abdomen or intravenous pyelography
Stones <1 cm may pass spontaneously with hydration and analgesia; otherwise, surgical intervention is needed
Treatment: hydration, alkalinization (oral potassium citrate) of the urine, and a low-purine diet
Allopurinol can be added if there are recurrent symptoms despite initial measures , especially if hyperuricosuria or hyperuricemia occurs
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Kidney Stones Cystine
Precipitation with decreased pH
Radiolucent on X ray; Sometimes visible on CT
Hexagonal crystals (pictured)
Associated with cystinuria
Staghorn calculi
Treatment: low sodium diet, alkalinization of urine (acetazolamide), chelating agents if refractory
Cyanide Nitroprusside Test
Think cystine stones when children present with nephrolithiasis
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Kidney Stones Calcium
Precipitated with calcium oxalate: hypocitraturia; or increased pH with calcium phosphate
Radiopaque on X ray and CT
Shaped like envelope (pictured) or dumbbell; (Calcium phosphate shaped like Wedgeshaped prism)
Calcium stones most common (80%); calcium oxalate more common than calcium phosphate stones
Hypocitraturia often associated with decreased urine pH
Can result from ethylene glycol (antifreeze) ingestion, vitamin C abuse, hypocitraturia, malabsorption (eg, Crohn disease), idiopathic hypercalciuria, renal tubular acidosis type 1
Acute renal failure is the major complication of ethylene glycol intoxidation
Hyperparathyroidism (calcium oxalate stone)
Treatment: thiazides (also used for calcium phosphate stones; decreases calcium urine levels), citrate, low-sodium diet
Crohns cause hyperoxaluria (causing stones)
High calcium intake reduces calcium oxalate stones by binding oxalate in the gut preventing it from entering circulation
Surgical resection of bowel and chronic diarrhea
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