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Pedi gu review nephrolithiasis

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George Chiang
George Chiang

This document discusses the classification, pathophysiology, presentation, imaging, laboratory evaluation and treatment of nephrolithiasis in pediatric patients. The main types of stones include calcium, uric acid, cystine and struvite. Important risk factors are hypercalciuria, hypocitraturia, hyperoxaluria and low urine volume. Treatment depends on stone size and location but may include extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy or open surgery. Diet and medical management target the underlying metabolic abnormalities promoting stone formation.

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Nephrolithiasis Pediatric GU Review UCSD Pediatric Urology George Chiang MD Sara Marietti MD Outlined from The Kelalis-King-Belman Textbook of Clinical Pediatric Urology 2007 (not for reproduction, distribution, or sale without consent)
Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Classification Calcium Stones Non-Calcium Hypercalciuria -Absorptive -Renal -Resorptive Uric Acid Hyperuricosuria Cystine Hyperoxaluria -Primary -Enteric Struvite Hypocitraturia -RTA I Amonium Acid Urate Hypomagnesuria Indinavir
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology Saturation Crystal growth and aggregation Supersaturation Crystal Retention Stone formation Nucleation
Presentation ,[object Object],[object Object],[object Object]
Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Imaging Radiopaque OR Radiolucent Calcium Oxalate Uric Acid Calcium phosphate Trimaterene Struvite Cystine Silica Xanthine
Laboratory Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Classification Calcium Stones Non-Calcium Hypercalciuria -Absorptive -Renal -Resorptive Uric Acid Hyperuricosuria Cystine Hyperoxaluria -Primary -Enteric Struvite Hypocitraturia -RTA I Amonium Acid Urate Hypomagnesuria Indinavir
Hypercalciuria ,[object Object],GI ABSORPTION PLASMA CA PTH URINARY CA
Absorptive Hypercalciuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypercalciuria ,[object Object],Urinary Calcium PTH GI Absorption Bone Resoprtion Plasma Calcium
Hypercalciuria ,[object Object],PTH Urinary Ca Bone Resorption GI Absorption Plasma Ca
Hypercalciuria Intestinal Absorption Fasting Urinary Ca PTH Serum Ca Resorptive Renal Absorptive High High High High High High High Low-nl High Normal Low-nl High
Hyperuricosuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary Hyperoxaluria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary Hyperoxaluria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Enteric Hyperoxaluria Bowel Disorder Fat malabsorption Excess fats bind to intestinal Ca Insufficient calcium to bind oxalate Unbound oxalate
Hypocitraturia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RTA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Type I RTA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Calcium Stones Misc ,[object Object],[object Object],[object Object]
Metabolic Classification Calcium Stones Non-Calcium Hypercalciuria -Absorptive -Renal -Resorptive Uric Acid Hyperuricosuria Cystine Hyperoxaluria -Primary -Enteric Struvite Hypocitraturia -RTA I Amonium Acid Urate Hypomagnesuria Indinavir
Uric Acid Lithiasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Uric Acid Lithiasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cystinuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Xanthinuria ,[object Object],[object Object]
Xanthinuria ,[object Object],[object Object]
Infection Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Misc Stones ,[object Object],[object Object],[object Object]
Dietary Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Pediatric GU Review II Endourology for stone disease
Etiology/Epidemiology ,[object Object],[object Object],[object Object],[object Object]
Etiology/Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Options ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Options ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Strategies ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Strategies ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Strategies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Strategies ,[object Object],[object Object],[object Object],[object Object],[object Object]
Question #1 ,[object Object],Low urinary volume Hyperoxaluria Hyperuricosuria Hypocitraturia Hypercalciuria
Question #2 ,[object Object],Oxalate
Question #3 ,[object Object],Resorptive Renal Absorptive
Question #4 ,[object Object],Thiazide diuretics augment calcium reabsorption in the distal and proximal tubules
Question #5 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Question #6 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Question #6 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Question #7 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Question #7 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Question #8 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Question #9 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Question #10 ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Pedi gu review nephrolithiasis

  • 1. Nephrolithiasis Pediatric GU Review UCSD Pediatric Urology George Chiang MD Sara Marietti MD Outlined from The Kelalis-King-Belman Textbook of Clinical Pediatric Urology 2007 (not for reproduction, distribution, or sale without consent)
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  • 6. Metabolic Classification Calcium Stones Non-Calcium Hypercalciuria -Absorptive -Renal -Resorptive Uric Acid Hyperuricosuria Cystine Hyperoxaluria -Primary -Enteric Struvite Hypocitraturia -RTA I Amonium Acid Urate Hypomagnesuria Indinavir
  • 7.
  • 8. Pathophysiology Saturation Crystal growth and aggregation Supersaturation Crystal Retention Stone formation Nucleation
  • 9.
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  • 12. Imaging Radiopaque OR Radiolucent Calcium Oxalate Uric Acid Calcium phosphate Trimaterene Struvite Cystine Silica Xanthine
  • 13.
  • 14. Metabolic Classification Calcium Stones Non-Calcium Hypercalciuria -Absorptive -Renal -Resorptive Uric Acid Hyperuricosuria Cystine Hyperoxaluria -Primary -Enteric Struvite Hypocitraturia -RTA I Amonium Acid Urate Hypomagnesuria Indinavir
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  • 19. Hypercalciuria Intestinal Absorption Fasting Urinary Ca PTH Serum Ca Resorptive Renal Absorptive High High High High High High High Low-nl High Normal Low-nl High
  • 20.
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  • 23. Enteric Hyperoxaluria Bowel Disorder Fat malabsorption Excess fats bind to intestinal Ca Insufficient calcium to bind oxalate Unbound oxalate
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  • 28. Metabolic Classification Calcium Stones Non-Calcium Hypercalciuria -Absorptive -Renal -Resorptive Uric Acid Hyperuricosuria Cystine Hyperoxaluria -Primary -Enteric Struvite Hypocitraturia -RTA I Amonium Acid Urate Hypomagnesuria Indinavir
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  • 38. Pediatric GU Review II Endourology for stone disease
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