acute nephrolithiasis

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acute nephrolithiasis

Which of the following is the most appropriate next step in management?
A. Initiation of thiazide diuretic therapy	starcraftbw, dr confused, Kamsi, suv	4	44%
B. Initiation of loop diuretic therapy		0	0%
C. Initiation of allopurinol therapy		0	0%
D. Maintenance of an alkaline urine		0	0%
E. Maintenance of large urine volumes via copious water consumption	Doc750, Justice, numita, ashraf786	4	44%
9 votes

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humar92004
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09/28/07 - 10:05 AM

A 31-year-old man comes to his physician's office two weeks after being seen in the emergency room for acute nephrolithiasis. He passed his stone in the emergency room and he reports that it was made of calcium oxalate. He is concerned about recurrences, as the pain was very severe. Which of the following is the most appropriate next step in management?

A. Initiation of thiazide diuretic therapy
B. Initiation of loop diuretic therapy
C. Initiation of allopurinol therapy
D. Maintenance of an alkaline urine
E. Maintenance of large urine volumes via copious water consumption

starcraftbw
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09/28/07 - 10:10 AM

Doc750
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09/28/07 - 10:11 AM

E

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sunny2
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09/28/07 - 10:15 AM

A, if he has a history of similar episodes.
D, if this was a first episode.

Doc750
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09/28/07 - 10:17 AM

isn't alkanize the urine for uric acid stones, not calcium oxalate?

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Justice
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09/28/07 - 10:17 AM

E. Maintenance of large urine volumes via copious water consumption

I go with it but the option sounds crazy... large urine volume, copious water consumption... Urologist recommend to drink enough water to have at least 2-2.5L/24 hr diuresis... This medical advice does not need to be induced by copious water consumption... They also recommend to drink something that contains citrate - to alkalinize urine, even for oxalate stones... But E should be initiated first as it hits the pathogenesis of the disease...

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Kamsi
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09/28/07 - 11:16 AM

A
for prevention of recurrence of the stone as it will cause more Ca reabsorption in the kidney
E is for treaatment in acute cases of nephrolithiasis

Justice
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09/28/07 - 11:30 AM

Kamsi wrote:
A
for prevention of recurrence of the stone as it will cause more Ca reabsorption in the kidney

Disagree. Thiazides are used when non-medicamental measureas fail to prevent from a recurrent stone formation

Kamsi wrote:
E is for treaatment in acute cases of nephrolithiasis

Only if the stone is small, usually 5-6 (some say 10) mm

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Kamsi
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09/28/07 - 11:59 AM

In all cases of nephrolithiasis Fluid >2L/day is given further mgt depends on the type of stone
Ca oxalate: dietary restriction of oxalate rich food,ascorbic acid,hypocalciuric diuretics like thiazides or amiloride ,K phosphate

Uric acid stone:Oral sodium bicarbonate to maintain alkaline urine

Cystine stone : Na bicarbonate
Struvite stone : maintaining urinart asepsis

doyoudig
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09/28/07 - 12:01 PM

#10

well this guy is comming to his regular MD for a follow up (Passed Stone Sponatneously so must have been small stone) and is asking about prevention of recurrences of oxalate stones
I will also go with Lost of Water Initially

doyoudig
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09/28/07 - 12:19 PM

#11

according to UW

• Recommendation for Prevention of Ca Oxalate Urolithiasis (In Order of Relative Importance)
1.↑ Fluid Intake
2.Normal or Increased Ca in the Diet – Recommended Daily Allowance is 1000 mg/dL
3.Dietary Na Restriction < 100 mEq/dL
4.Decreased Dietary Proteins & Oxalate (e.g. Beef, Fish, Eggs, Poultry)
– Recommended in Pts w/ Uric Acid Stones 2ndary to Hyperuricosuria

doyoudig
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09/28/07 - 12:26 PM

#12

Incr Fluid Intake
Restrict Na
Thiazides

humar92004
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09/29/07 - 10:31 AM

#13

tHANK YOU

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