Nephrolithiasis - Revision history

Aidan at 19:43, 19 August 2024

2024-08-19T19:43:23Z

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-== Epidemiology ==
+== Background ==
 * 10% lifetime prevalence in men, 5% in women
-== Pathophysiology ==
+=== Stone Types ===
 * Low urine output/poor oral intake
 * Increased uric acid, which precipitates in low pH
@@ Line 21: / Line 55: @@
 * [[Urinary tract infection]] caused by [[urease-positive]] bacteria, leading to [[struvite stones]]
 * Urinary stasis, e.g. in polycystic kidney disease, medullary sponge kidney
-* Medications, especially HIV medications
+* Medications, including [[atazanavir]] and other HIV medications, [[guiafenesin]], [[indinavir]], [[sulfonamides]], and [[triamterene]]
 == Investigations ==

Aidan: Aidan moved page Renal calculus to Nephrolithiasis

2024-08-19T17:23:35Z

Aidan moved page Renal calculus to Nephrolithiasis

← Older revision	Revision as of 17:23, 19 August 2024
(No difference)

Aidan: Aidan moved page Renal calculi to Renal calculus without leaving a redirect

2024-08-19T17:23:23Z

Aidan moved page Renal calculi to Renal calculus without leaving a redirect

← Older revision	Revision as of 17:23, 19 August 2024
(No difference)

Aidan at 19:47, 5 July 2020

2020-07-05T19:47:03Z

← Older revision		Revision as of 19:47, 5 July 2020
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	* Decreased citrate (i.e. 3 bicarbs), e.g. from RTA		* Decreased citrate (i.e. 3 bicarbs), e.g. from RTA
	* Increased phosphate, e.g. from carbonated beverages, which precipitates in high pH		* Increased phosphate, e.g. from carbonated beverages, which precipitates in high pH
	* ~~Urease-producing urinary~~ tract infection, leading to struvite stones		* [[Urinary tract infection]] caused by [[urease-positive]] bacteria, leading to [[struvite stones]]
	* Urinary stasis, e.g. in polycystic kidney disease, medullary sponge kidney		* Urinary stasis, e.g. in polycystic kidney disease, medullary sponge kidney
	* Medications, especially HIV medications		* Medications, especially HIV medications

Maintenance script: Imported from text file

2020-07-04T01:17:54Z

Imported from text file

New page

== Epidemiology ==

* 10% lifetime prevalence in men, 5% in women

== Pathophysiology ==

* Low urine output/poor oral intake
* Increased uric acid, which precipitates in low pH
* Low pH, which precipitates animal protein
* Hypercalciuria
** Genetic (familial)
** Hypercalcemia: hyperparathyroidism, vitamin D
* Increased oxalate
** Genetic
** Diet: nuts, greens, chocolate, etc.
** IBD: fatty acids bind to calcium in gut, allowing oxalate absorbtion
** Malabsorption
** Vitamin C
* Decreased citrate (i.e. 3 bicarbs), e.g. from RTA
* Increased phosphate, e.g. from carbonated beverages, which precipitates in high pH
* Urease-producing urinary tract infection, leading to struvite stones
* Urinary stasis, e.g. in polycystic kidney disease, medullary sponge kidney
* Medications, especially HIV medications

== Investigations ==

* Dietary assessment
* Electrolytes (especially for K and HCO3), calcium profile, PTH, urinalysis, urine microscopy
* 24h urine collection, sent for
** volume
** creatinine, CrCl
** Na, K, urea
** calcium
** oxalate
** uric acid
** phosphate
** spot test for cystine
** citrate and magnesium in a separate collection

== Management ==

* Imaging
* Stone diet
** Maintain urine output 2L/d
** Low salt
** Normal calcium
** Increased fruit and vegetables
** Moderate meat and alcohol
* Potassium citrate 20mEq BID, to increased citrate and pH of the urine
* Hydrochlorothiazide, to decrease urine calcium
* Allopurinol, to decrease urine urate

[[Category:Nephrology]]