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N450_ renal (1)
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Exam of 5 pages for the course N450 - Ch. 3 - Principles of Geriatrics at N450 - Ch. 3 - Principles of Geriatrics (N450_ renal (1))
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N450: renalUrinary Tract Calculi - ANS-•1 to 2 million in United States have nephrolithiasis
•More common in men
•Average age at onset: 20-55 years
•Increased incidence
stone formation - ANS-•No single etiology for all cases
-metabolic
-genetic
-climate
-diet
metabolic - ANS-•Increased calcium
•Increased acids: oxaluric, uric, citric
genetic - ANS-family history
gout
diet - ANS-•Proteins
•Tea
•Calcium
•Oxalate
•Fluids
stone formation affected by - ANS--Urinary pH:
•Alkaline: calcium, phosphorus
•Acidic: uric acid, cystine
-Solute load
•Precipitates
other factors - ANS--Obstruction with urinary stasis
-UTI
•Proteus, Klebsiella, Pseudomonas, & some Staphylococcus
-Genetics
•Autosomal recessive disorder
types of calculi - ANS--calcium oxalate 35-40%
-calcium phosphate
-struvite 10-15%
-uric acid
-cystine
, Calcium oxalate - ANS-•Small stones
•Ureter
•Men > women
Calcium phosphate - ANS-•Mixed stones
•Alkaline urine
•Primary hyperparathyroidism
struvite - ANS-•UTI's
•Staghorn
•Women > men
uric acid - ANS-gout
cystine - ANS-acidic urine
Clinical Manifestations - ANS-•Sudden severe pain due to obstruction
Common sites of obstruction - ANS--Ureteropelvic junction (UPJ)
•Dull pain in costovertebral flank
•Renal colic
-Ureterovesicular junction (UVJ)
diagnostic - ANS-•Non-contrast spiral CT (CT/KUB)
•ULS
•IVP
Complete urinalysis to assess for - ANS--Hematuria
-Crystalluria
Collaborative Care - ANS-•Acute attack
•Treat pain: opioids
•Infection
•Obstruction
assessment for cause
Patients with active stone formation teaching - ANS--Adequate hydration
-Dietary sodium restrictions
-Dietary changes
-Drugs to minimize stone formation
Indications for endourologic stone removal, lithotripsy, or open surgical stone removal -
ANS--Stones too large for passage
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