CC Sept 2018 Prevention of Recurrent Kidney Stones

echoecho's version from 2018-11-12 01:55


Question Answer
Kidney stones affects about one American in _____?11
Treatment for an intial episode of kidney stones involves?1) vigorous hydration 2)analgesia
Urological intervention may be required for what?an obstructing stone that does not pass or in the presence of a UTI
An evaluation is necessary even after only one episode of kidney stones and up to ____% of patients will suffer a recurrent episode?50
In 2014, the American Urological Association (AUA) issued a guideline to reduce the risk of recurrence that includes what categories?1) hx and physical exam 2) lab evlauation 3) diagnostic imaging 4) prevention and treatment
Obtain medical hx, dietary hx, serum chemistries and urinalysis on all patients with specific focus on certain medical conditions that increase the riks of kidney stones. List medical conditions, dietary factors and medications and supplements?1) medical conditions (obesity, hyperthyroidism, gout, DM, hyperparathyroidism, hx of bariatric surgery) 2) dietary factors (low fluid intake, high dietary purine intake, high dietary sodium intake, intake of sugar-sweetened beverages) 3) medications and supplements (Probenecid, Protease inhibitors (tipranavir (Aptivus), indinavir (Crixivan), Lipase inhibitors (Orlistat (Xenical), Triamterene (Dyrenium), Chemotherapeutic agents, Vitamin C, Vitamin D, calcium, carbonic anhydrase inhibitors (Acetazolamide (Diamox), Methazolamide (Neptazane)
If a stone is recovered, either surgically or through straiing of urine, it shoulde be sent for what?analysis because identification of the type of stone may help to direct specific preventive measures
80% of stones recovered are comprised of what type of stones?1) calcium oxalate 2) calcium phosphate
5-10% of recovered stones are comprised of what type of stones?1) uric acid 2) struvite stone 3) cystine stones
Metabolic testing is recommended in what patients?1) those who have had a kidney stone 2) those who are considered at high-risk (known hyperparathyroidism) or who have a solitary kidney
What test should be ordered if hyperparathyroidism is suspectedC?PTH
Hypercalciuria is a common finding but other conditions, list these, may be present?1) hypercalcemia 2) hyperuricemia 3) increased urinary excretion of oxalate, uric acid
*** Because of high variability in excretion of many relevant substances, it is recommended to obtain at least ____ - 24 hour urine collections on a random diet for total volume, pH, calcium, oxalate, uric acid, citrate, sodium, potassium and creatinine?two
Films used to dx the initial episode of nephrolithiasis should be reviewed, why?the presence of multiple stones increases the risk of recurrent symptomatic episodes
All patients should be instructive to drink at least ____L fluid per day to produce ____ L of urine per day?2.5; 2.0
The above can be assessed from _____ hour urine collections?24
Afterward, the patient is advised to adjust _____ intake accordingly?fluid
Observation studies have shown that higher levels of fluid intake reduce the risk of kidney stone formation, is there a definite threshold?no
Eliminating _____ sweetened beverages from the diet is recommended as it has been shown an increased risk of kidney stone recurrence?sweet
Excessive fluid intake may lead to ________, thus, sodium levels should be monitored periodically?hyponatremia
*** Individuals with calcium stones and elevated urinary calcium excretion should reduce their sodium intake to < _____ mg/day and limit their daily calcium intake to ______ to _____ mg/day?2300; 1000; 1200
For those whom calcium supplementation is recommended (those w/ osteoporosis), a 24 hour urinary calcium can be obtained both on and off supplementation; if the urinary calcium remains high after discontinuing the supplement, what should be done?it should not be restarted