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the most commonly presented symptom of nephrolithiasis
left flank pain
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what did the CT scan show
- 6mm stone in left mid-ureter
- 1mm stone in inferior calyx of right kidney
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any past history of stones
yes ages 35,43,52 (all passed spontaneously)
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what 2 way are stones classified
- location - kiney, ureter, bladder
- composition - calcium, struvite, uric acid, cystine
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what 2 way are stones classified
- location - kiney, ureter, bladder
- composition - calcium, struvite, uric acid, cystine
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was there an increase or decrease in incidence rate of stones in the last 10-15 yrs and why
40% increase, unknown
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give the prevelance of stones
- men, caucasians, between ages 20 & 40,
- rare in: children and first attach in adults >50
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75% of stone cases are composed of what
calcium (oxalate or phosphate)
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what 5 risk factors did stone patient have
male, caucasian, sedentary lifestyle, previous stone formation, dehydration
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3 main S&S stones patient had
- excrutiating pain in the side and back, below the ribs
- inability to remain still
- N/V
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what is present in the urine in 90% of stone cases
red blood cells
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how does urine pH determine type of stone
- pH below 5.5 - uric acid or cystine
- pH above 7.2 - struvite and calcium phosphate
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underlying cause of 3 types of stones
- cystine - congenital cystinuria
- struvite or carbonate - UTI with urease positive organism
- primary calcium phosphate - acidification defects
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4 types of kidney stones according to location
- staghorn - major & minor calices
- non-staghorn - calyceal or pelvic
- ureter - anywhere with in
- bladder - obvioulsly
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most abundant organic anion in human urine and 2 roles
- citrate
- permits base excretion w/o raising urine pH
- facilitates excretion of Ca in a soluable form
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4 stone/crystal growth inhibiting substances
- Tamm-Horsfall protein
- Potassium citrate
- pyrophosphate
- magnesium
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3 invasive treatments for stones
- shock wave therapy
- percutaneous nephrolithotomy
- open operative intervention
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what is the treatment for type II hypercalciuria
reduce Ca intake by 50%
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what type of stones did patient have
calcium oxalate
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was specific gravity high or low and why
high - dehydration
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what was recommended, to decrease the intake of, to our patient
oxalates (fruits, vegetables, nuts)
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