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Kidney Stones

Published on Mar 24, 2016

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PRESENTATION OUTLINE

1.

Kidney Stones

joel topf
Photo by Alex E. Proimos
2.

Untitled Slide

3.

Summary

Photo by Leo Reynolds
4.

screening evaluation

  • Medical history
  • Dietary history
  • Chemistries, uric acid and PTH
  • Urinalysis, culture and sensitivity
  • Stone evaluation
  • Imaging: CT scan or ultrasound
  • 24 or 48 hour urine collection
Photo by Seattle Municipal Archives
5.

Diet therapies

  • 2.5 liters of water a day
  • Low sodium diet
  • Low oxalate diet
  • Increased fruits and veggies
  • Decreased animal protein
Photo by Chris Yarzab
6.

Pharmacologic therapies

  • Thiazide diuretics
  • Potassium citrate
  • Allopurinol
Photo by EssjayNZ
7.

follow up

  • Repeat 24 hour urine
  • Chemistries
  • Imaging: Ultrasound, CT scan
  • Interim history
Photo by Christiana Care
8.

Cocktail Chatter

Photo by Comicbase
9.

1 in 11

Kidney stones affect
Photo by Hey Paul Studios
10.

50%

recurrence in 10 years
Photo by Mark Seton
11.

50%

recurrence in 10 years
Photo by Mark Seton
12.

Men > Women

7% in women, 11% in men but gender gap is decreasing

1.7:1 in 1997 to 1.3:1 in 2002

increase in stone disease among women, rather than a decline among men
Photo by hiromy
13.

Increasing

incidence seems to be
NHANES reported a 70% increase in prevalence from '88-'94 to '07-'10
Photo by krapow
14.

Unmodifiable Risk Factors

  • Obesity
  • Hypertension
  • Diabetes
  • Gout
Photo by Tobyotter
15.

Modifiable Risk factors

  • low calcium intake
  • low fluid intake
  • sugar-sweetened beverages
  • animal protein
Photo by † David Gunter
16.

Best diet:
low sodium, low animal protein, normal calcium

Photo by spoony mushroom
17.

avoid colas

NHANES reported a 70% increase in prevalence from '88-'94 to '07-'10
Photo by JeepersMedia
18.

Do not go adopt a low calcium diet

NHANES reported a 70% increase in prevalence from '88-'94 to '07-'10
Photo by Stephanie Booth
19.

The Guidelines

NHANES reported a 70% increase in prevalence from '88-'94 to '07-'10
Photo by tanakawho
20.

Screening visit

Photo by Jonas B
21.

Past Medical History

  • obesity
  • hyperthyroidism
  • gout
  • renal tubular acidosis (RTA) type 1
  • diabetes mellitus type 2
  • bone disease
Photo by *Muhammad*
22.

Untitled Slide

  • primary hyperparathyroidism
  • malabsorptive gastrointestinal states
  • bowel resection
  • bariatric surgery
  • pancreatic disease
Photo by Hey Paul Studios
23.

dietary history

  • calcium intake below or above the RDA
  • low fluid intake
  • high sodium intake
  • low intake of fruits and vegetables
  • high intake of animal-derived purines
Photo by Chris Yarzab
24.

medication history

  • probenecid
  • lipase inhibitors (orlistat)
  • triamterene
  • chemotherapy
  • vitamin C, vitamin D, calcium
  • carbonic anhydrase inhibitors: topiramate, acetazolamide, zonisamide
  • HIV medicines (indinavir)
  • acyclovir
Photo by Charles Williams
25.

Lab studies

  • basic metabolic profile
  • uric acid
  • urinalysis / C&S
  • PTH intact
  • 25 OH Vitamin D
Photo by Amy Loves Yah
26.

stone composition

  • Calcium oxalate (80%)
  • Calcium phosphate (10%)
  • Uric acid (10%)
  • Struvite
  • Cystine
Photo by rkramer62
27.

24 or 48 hour urine

  • Sodium
  • Potassium
  • Uric acid
  • Oxalate
  • Calcium
  • Creatinine
  • pH
Photo by Julie Oreo
28.

Litholink

29.

2.5 liters of urine

not just fluid intake but urine
Photo by stevendepolo
30.

low sodium diet
lowers urine calcium

Photo by Stephen Begin
31.

low calcium diet
increases stones

Photo by Dawn Endico
32.

drug therapy

Photo by Charles Williams
33.

potassium citrate
all calcium and
uric acid stones

Photo by DrChino
34.

thiazide diuretics for
high urinary calcium

Photo by WilliamMarlow
35.

thiazide diuretics
high urinary calcium

36.

allopurinol
for calcium stones
NOT for uric acid stones

Photo by Sarah G...
37.

follow up visits

Photo by mjmonty
38.

plan

  • Interim history
  • Chemistries
  • Imaging
  • 24 or 48 hour urine

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