limit beef, chicken, pork, eggs, fish, shellfish, and other animal proteins
limit beans, nuts, chocolate, coffee, dark green vegetables, and soda
limit canned, packaged, and fast foods
limit milk, cheese, and other dairy products
B. limit beans, nuts, chocolate, coffee, dark green vegetables, and soda
dissolves cystine stones
enhances nephrocalcinosis process over old scared areas
inhibits Ca.oxalate aggregation and crystallization
plays a secondary role in metastatic calcification process
chemical analysis of a recovered stone
hypercalcemia
CT finding
high breakability on ESWL
it causes reduction in the mean intra-ureteral pressure
it reduces the pain of acute renal colic
it has a direct relaxing effect on the renal pelvis and ureteral musculature
it is indicated when stones are ≤ 4 mm in diameter
α-Mercaptopropionylglycine
acetohydroxamic acid
carbonic anhydrase inhibitors
xanthine oxidase inhibitors
stone chemical composition
stone burden
first stone vs. recurrent
stone density
formation of triple-phosphate stones
infection with Proteus species
increase production of endogenous uric acid
increase level of uric acid in THE blood
classical nucleation theory
heterogeneous nucleation
suspension solution
concentric lamination
result from an inherited defect of renal tubular reabsorption of cysteine
characteristically, urate and cysteine stone are radiolucent
cysteine is a dibasic amino acid
on plain X-ray, cysteine stones exhibit ground-glass appearance
hypertensive patient
patient on aspirin withheld 5 days prior to ESWL
a stone in a scared poorly functioning kidney
ESWL every other day
Proteus mirabilis
E. coli
Pseudomonas aeruginosa
Staphylococcus epidermidis
it is characterized by low urinary magnesium and citrate
magnesium increases renal tubular citrate resorption
diarrheal is a remarkable side effect of magnesium therapy
potassium-magnesium preparations might restore urinary magnesium and citrate levels
0 10%
10 20%
20 30%
30 40%
should be treated with more analgesics
must undergo metabolic worked out
are unlikely to pass out spontaneously
chemolysis should be tried first
best treated by total parathyroidectomy
first-time stone formers are at a 50% risk for recurrence
males have higher recurrence rate than females
stone formers produce stones of the same type every time
steinstrasse
a stone in ureterocele
fever, leucocytosis, pain
brushite stones
ESWL
PCNL
radial nephrolithotomy
pyelolithotomy with ureteral stenting
size of 5 mm
location at the lower calyx
density of 400 HU
being recurrent
stone size
unrelieved obstruction
infection and septicemia
recurrent stone formation
increase urinary calcium, oxalate, and uric acid excretion
decrease urinary calcium; but increase oxalate, and uric acid excretion
increased urinary calcium and uric acid; but decrease oxalate excretion
decreased urinary calcium, oxalate, and uric acid excretion
commonly occur in patients with senile prostatic enlargement
common in children exposed to low-protein, low-phosphate diet
rarely recur after treatment
respond to ESWL
terminal ilium resection
liver transplantation
kidney transplantation
regular hemodialysis
stones in a solitary kidney
ureteral stones causing bilateral obstructions
a kidney stone of ≥ 2.5 cm in size
all of the above
ESWL
PCNL with fulguration of the diverticulum
ureteroscopy with fulguration of the diverticulum
pyelolithotomy with diverticulectomy
can be introduced from the bladder or kidney or any part of the ureter`s course
the standard adult size is 32 cm long, 4 mm calibre
might result in encrustations and ureteral obstruction
might result in ureteral dilation
left ureterocele
bifid right renal pelvis
neurogenic bladder
bilateral UPJ stenosis
Ca.oxalate, Ca.phosphate, Na.urate, cystine
Ca.phosphate, Ca.oxalate, cystine, Na.urate
Ca.oxalate, Ca.phosphate, cystine, Na.urate
Ca.phosphate, Ca.oxalate, Na.urate, cystine
a stone is fragmented when the force of the shockwaves overcomes the tensile strength of the stone
fragmentation occurs as a result of compressive and tensile forces, erosion, shearing, spalling, and cavitation
the generation of compressive and tensile forces and cavitation are thought to be the most important
all of the above
≥ 2 cm diameter
upper calyx location
Na.urate composition
600 - 800 HU density
the surface area of the stones
the volume of the stones
the density of the stones
the number of the stones
piezoelectric
electrohydraulic
electromagnetic
microexplosive