AAAAA
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A 25-year-old man with a history of active Crohn's disease with several small-bowel resections is evaluated for recurrent calcium oxalate kidney stones. He typically passes three to four stones each year and he becomes incapacitated during acute attacks. He requests further therapy for stone prevention.
A plain abdominal radiograph is obtained in the office and reveals no calcifications in the genitourinary tract.
Laboratory Studies Uric acid 6.8 mg/dL (0.4 mmol/L) Blood urea nitrogen 10 mg/dL (3.57 mmol/L) Creatinine 0.8 mg/dL (70.74 μmol/L) Sodium 139 meq/L (139 mmol/L) Potassium 4.3 meq/L (4.3 mmol/L) Bicarbonate 25 meq/L (25 mmol/L) Calcium 9.9 mg/dL (2.47 mmol/L) Phosphorus 2.2 mg/dL (0.71 mmol/L) Urinalysis pH 5.0, no blood or protein
In addition to increasing fluid intake, which of the following recommendations is warranted?
A Calcium intake >1 g/d
B A high-sodium diet
C A high-protein diet
D Furosemide, 40 mg/d
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| Justice
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None of the answers make sense to me... At lealt none of those are preventive... High uptake of Ca won't help... A choose (D)
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| sprint123
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I think calcium intake will bind with the oxalate preventing stones?!
I go with A.
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| dr.wad
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( D )
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| Justice
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From personal experience: they recommend thiozides, not high Ca uptake, to treat oxalate stones... They also say that high Ca intake have same effect as high oxalate intake... We know that Furosemide causes Ca excretion with urine, that may increase Ca con-n in urine, but if this is accompanied with high urine flow, this may decrease the chance for calculus formation... Again, very vague Q
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| mdwannabe
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High protein intake...will Alkalanize the urine...decrease chance of CaOxal stone formation...
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| me007
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i guess it's pathophis of oxalate kidney stones in Crohn's.
normally, dietary Ca binds to dietary oxalate, and this complexs excreted.
In Crohn's excess of lipids in bowel lumen bind Ca, oxalate left unbinded in lumen --> absorbed -->stones
A.
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| Justice
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me007 wrote:
i guess it's pathophis of oxalate kidney stones in Crohn's.
normally, dietary Ca binds to dietary oxalate, and this complexs excreted.
In Crohn's excess of lipids in bowel lumen bind Ca, oxalate left unbinded in lumen --> absorbed -->stones
A.
Very convincing...
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| doc_clotaire
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AAA can you post the answer to that question please !
This is a good one !
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| docnikki
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I go with A..explaination same as me007..thats what is given in UW.
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| nadiabarati
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A
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| neuroblastoma
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yes. A
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| dr.wad
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AAAAAAAAAAAAAAAAAA
could u plz post the answer.
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| star1
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A Calcium intake >1 g/d we cant give as it will aggravate the stone condition
B A high-sodium diet , no benefit
C A high-protein diet .. It will also increase stone formation
D Furosemide, 40 mg/d .... Loope lose Ca, Low dose diuretic are sometime beneficial
so My answer DDDD
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| Justice
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star1 wrote:
A Calcium intake >1 g/d we cant give as it will aggravate the stone condition
B A high-sodium diet , no benefit
C A high-protein diet .. It will also increase stone formation
D Furosemide, 40 mg/d .... Loope lose Ca, Low dose diuretic are sometime beneficial
so My answer DDDD
Glad that discussion of this Q is back... I also think it is D, but me007 hit it right...
AAAAA, could you please post the correct answer?
Thanks...
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| neuroblastoma
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answer A....normally, dietary Ca binds to dietary oxalate, and this complexs excreted.
In Crohn's excess of lipids in bowel lumen bind Ca, oxalate left unbinded in lumen --> absorbed -->stones
A.
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| krsna
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I too think its A...
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| new_n_lost
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Nope Guys Giving Him a Thiazide wud be beneficial but a Loop wont be effective Although Me007 has posted the Right Pathophysio behind the Calcium -Oxalate relationship the ans has to be A given the Choices
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| sachida
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I would go with Ans A because of already described pathophysiology and also because Ca prevents osteoporosis and conon cancer. Also high calcium in their diet does NOT increase their chances of getting stone.
D also looked very tempting to me. But evidently, there is no increased serum ca levels and radiograph had no stone.
Here is dietery recommendations for patients with IBD
Dietary Considerations for Reducing Kidney Stones
Kidney stones are painful and common complications in IBD, particularly in patients who have had intestinal surgery. IBD patients are at risk for the most common types of stones--those composed of either calcium oxalate or uric acid crystals. The following are some considerations in reducing the risk for stones:
The most important dietary recommendations for reducing the risk for kidney stones are increasing fluid and restricting sodium intake.
Limiting protein is recommended for reducing kidney stones. Of note, however, people with IBD with frequent diarrhea are protein deficient. Sufficient protein, particularly in children with IBD, is very important and should be weighed against any risk for stones.
Patients should increase intake of potassium-rich foods.
Patients should try to correct any dietary habits that cause acidic or alkaline imbalances in the urine that promote stone formation.
Many kidney stones are formed from calcium-oxalate stones. Patients should avoid or limit intake oxalate-rich foods, such as beets, beet tops, black tea, chenopodium, chocolate, cocoa, dried figs, ground pepper, lamb quarters, lime peel, nuts, parsley, poppy seeds, purslane, rhubarb, sorrel, spinach, and Swiss chard. A high calcium diet does not appear to increase the risk for kidney stones as long as it also contains plenty of fluids and dietary potassium and phosphate. Importantly calcium is associated with protection against colon cancer and osteoporosis--two conditions that are associated with IBD.
Patients who have stones associated with short-bowel syndrome should restrict their intake of fat as well oxalates. In such cases, calcium may bind to unabsorbed fat instead of to oxalates, which increase oxalate levels.
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| snake0613
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I think A,if D, it causes more stones
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