Stones: Diagnosis and Evaluation: Difference between revisions
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*****High intake of animal-derived purines | *****High intake of animal-derived purines | ||
**'''<span style="color:#ff0000">Medications</span>''' | **'''<span style="color:#ff0000">Medications</span>''' | ||
***'''Stone-provoking medications or supplements (9):''' | ***'''<span style="color:#ff0000">Stone-provoking medications or supplements (9):''' | ||
***#'''Triamterene''' | ***#'''<span style="color:#ff0000">Triamterene''' | ||
***#'''Carbonic anhydrase inhibitors such as topiramate, acetazolamide, zonisamide''' | ***#'''<span style="color:#ff0000">Carbonic anhydrase inhibitors such as topiramate, acetazolamide, zonisamide''' | ||
***#'''Probenecid''' | ***#'''<span style="color:#ff0000">Probenecid''' | ||
***#'''Some protease inhibitors''' | ***#'''<span style="color:#ff0000">Some protease inhibitors''' | ||
***#'''Lipase inhibitors''' | ***#'''<span style="color:#ff0000">Lipase inhibitors''' | ||
***#'''Chemotherapy''' | ***#'''<span style="color:#ff0000">Chemotherapy''' | ||
***#'''Vitamin C''' | ***#'''<span style="color:#ff0000">Vitamin C''' | ||
***#'''Vitamin D''' | ***#'''<span style="color:#ff0000">Vitamin D''' | ||
***#'''Calcium''' | ***#'''<span style="color:#ff0000">Calcium''' | ||
====Physical Exam==== | ====Physical Exam==== | ||
*'''General''' | *'''General''' | ||
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*'''Flank''' | *'''Flank''' | ||
**'''Costovertebral tenderness''' | **'''Costovertebral tenderness''' | ||
===Laboratory=== | ===Laboratory=== | ||
====<span style="color:#ff0000">Urinalysis +/- culture +/- microscopy</span>==== | ====<span style="color:#ff0000">Urinalysis +/- culture +/- microscopy</span>==== | ||
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*#Stones composed of cystine, uric acid, and struvite | *#Stones composed of cystine, uric acid, and struvite | ||
*#Children should generally be evaluated because of concerns about renal damage and long-term sequelae of stone recurrence | *#Children should generally be evaluated because of concerns about renal damage and long-term sequelae of stone recurrence | ||
==== | ==== 24-hour urine collections==== | ||
*Can be used to inform and monitor treatment protocols | *Can be used to inform and monitor treatment protocols | ||
*'''<span style="color:#ff0000">Analyzed at minimum for (9): [https://pubmed.ncbi.nlm.nih.gov/24857648/ ★]</span>''' | *'''<span style="color:#ff0000">Analyzed at minimum for (9): [https://pubmed.ncbi.nlm.nih.gov/24857648/ ★]</span>''' | ||
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*#Sulfate can be added to assess the volume of protein loading from animal meat | *#Sulfate can be added to assess the volume of protein loading from animal meat | ||
*The accuracy of a 24-hour urine collection should be assessed prior to interpretation of results. | *'''The accuracy of a 24-hour urine collection should be assessed prior to interpretation of results.''' | ||
**'''To assess the adequacy of collection, 24-hour urinary creatinine excretion, taking into account patient gender and body weight, | **'''<span style="color:#ff0000">To assess the adequacy of collection, 24-hour urinary creatinine excretion should be evaluated</span>, taking into account patient gender and body weight, as well as patient recall of the start and end times of his or her collection, should be considered''' | ||
***'''Significant aberrations in total creatinine excretion from estimated volumes (males 20-25mg/kg and females 15-20mg/kg in 24 hours) imply incomplete collection, overcollection, greater than expected muscle mass, or less than expected muscle mass''' | ***'''<span style="color:#ff0000">Significant aberrations in total creatinine excretion from estimated volumes (males 20-25mg/kg and females 15-20mg/kg in 24 hours) imply incomplete collection, overcollection, greater than expected muscle mass, or less than expected muscle mass''' | ||
****For abnormally collected 24 hour urine collections, can divide metabolite excretion by creatinine excretion to compare collections | ****For abnormally collected 24 hour urine collections, can divide metabolite excretion by creatinine excretion to compare collections | ||
*'''Markers of protein intake, such as urine urea nitrogen or urinary sulfate, are reflective of animal protein intake and can be used to assess dietary adherence'''. | *'''Markers of protein intake, such as urine urea nitrogen or urinary sulfate, are reflective of animal protein intake and can be used to assess dietary adherence'''. | ||
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*If a patient with calcium urolithiasis uses calcium supplements, 24-hour urine samples should be collected on and off the supplement. | *If a patient with calcium urolithiasis uses calcium supplements, 24-hour urine samples should be collected on and off the supplement. | ||
**If urinary supersaturation of the calcium salt in question increases during the period of supplement use, the supplement should be discontinued. | **If urinary supersaturation of the calcium salt in question increases during the period of supplement use, the supplement should be discontinued. | ||
==Questions== | ==Questions== | ||
#What is the risk of stone recurrence at 10 years in first-time stone formers? | #What is the risk of stone recurrence at 10 years in first-time stone formers? | ||