Nephrolithiasis

Urinary lithiasis is a disease in which calculi form in the kidney and urinary tract. Roughly 5 % of the human population suffers to some degree from urinary lithiasis. A number of severely afflicted patients (e.g. ca. 60,000 in West Germany and more than 100,000 in the U.S.) are hospitalized yearly for major surgical treatment. Obviously, nephrolithiasis is not only a common ailment but also an issue of great social and economic consequence. 

Kallistratos, G. Litholytic Agents Preventive and Curative Drugs for Nephrolithiasis, in Drug Design, Vol. IV, Academic Press, Inc., New York and London 1973... 

Data in part from Ackerman NJ, Clapham DE Ion channels— basic science and clinical disease. N Engl J Med 1997,-336 1575. Other channelopathies include the long QT syndrome (MIM 192500) pseudoaldosteronism (Liddle syndrome, MIM 177200) persistent hyperinsulinemic hypoglycemia of infancy (MIM 601820) hereditary X-linked recessive type II nephrolithiasis of infancy (Dent syndrome, MIM 300009) and generalized myotonia, recessive (Becker disease, MIM 255700). The term "myotonia" signifies any condition in which muscles do not relax after contraction. 

Congenital, familial, and metabolic disorders (e.g., congenital obstructive uropathy, Fabry s disease, medullary cystic disease, and nephrolithiasis)... 

Long-term consequences of gout and hyperuricemia include joint destruction, tophi, and nephrolithiasis. 

Patients with recurrent attacks, evidence of tophi or joint destruction, or uric acid nephrolithiasis are candidates for maintenance therapy with allopurinol or probenecid to lower serum uric add levels. 

Uric acid excretion is reduced in patients with chronic kidney disease, putting them at risk for hyperuricemia. In patients with persistently acidic urine and hyperuricemia, uric acid nephrolithiasis can occur in up to 25% of patients in severe cases, uric acid stones can cause nephropathy and renal failure. Extreme hyperuricemia can occur because of rapid tumor cell destruction in patients undergoing chemotherapy for certain types of cancer (see Chap. 85). 

Some drugs can cause hyperuricemia and gout, such as thiazide diuretics, niacin, pyrazinamide, cyclosporine, and occasionally, low-dose aspirin. In most cases, these drugs block uric acid secretion in the kidney. Long-term consequences of gout and hyperuricemia include joint destruction, tophi, and nephrolithiasis. 

Indinavir (IDV) 200-, 333-, 800 mg q8hours Mild to moderate hepatic For unboosted IDV Nephrolithiasis Gl intolerance, CYP3A4 inhibitor... 

Nephrolithiasis/ urolithiasis/ crystalluria IDV Onset Any time after initiation of therapy, especially if 4- fluid intake Symptoms Flank pain and/or abdominal pain, dysuria, frequency pyuria, hematuria, crystallauria rarely, Tserum creatinine and acute renal failure 1. History of nephrolithiasis 2. Fhtients unable to maintain adequate fluid intake 3. High peak IDV concentration 4. tDuration of exposure Drink at least 1.5-2 L of non-caffeinated fluid per day Tfluid intake at first sign of darkened urine monitor urinalysis and serum creatinine every 3-6 months Increased hydration pain control may consider switching to alternative agent stent placement may be required... 

Nephrolithiasis A condition marked by the presence of renal calculi (stones) in the kidney or urinary system. 

Protease inhibitors Hepatotoxicity hyperlipidemia, nephrolithiasis, lipodystrophy... 

The answer is a. (Katzung, pp 255-256.) Thiazide diuretics can be used in the treatment of nephrogenic diabetes insipidus. Its other uses include the treatment of hypertension, CHF, and nephrolithiasis due to idiopathic hypercalcuria. 

The term gout describes a disease spectrum including hyperuricemia, recurrent attacks of acute arthritis associated with monosodium urate crystals in leukocytes found in synovial fluid, deposits of monosodium urate crystals in tissues (tophi), interstitial renal disease, and uric acid nephrolithiasis. 

Uric acid nephrolithiasis occurs in 10% to 25% of patients with gout. Predisposing factors include excessive urinary excretion of uric acid, acidic urine, and highly concentrated urine. 

The most common side effects are ataxia, impaired concentration, confusion, memory difficulties, dizziness, fatigue, paresthesias, and somnolence. Nephrolithiasis occurs in 1.5% of patients. It has also been associated with acute narrow-angle glaucoma, oligohidrosis, and metabolic acidosis. 

Prostatic hypertrophy, infection, cancer Improperly placed bladder catheter Anticholinergic medication Cancer with abdominal mass Retroperitoneal fibrosis Nephrolithiasis Nephrolithiasis Oxalate Indinavir Sulfonamides Acyclovir Uric acid... 

Chronic hypercalcemia (i.e., hyperparathyroidism) is associated with metastatic calcification, nephrolithiasis, and chronic renal insufficiency. 

Obstructive nephropathy Intratubular obstruction OKT3 Nephrolithiasis... 

The proteinuria and aminoaciduria, and acidosis and glucosuria where they occur, are probably caused by reversible inhibition of some functions of the renal tubule. There would appear to be no structural damage to the kidney. However, 2 children developed nephrolithiasis while being treated with a low-lactose diet (B7, C5), The time course of events, when galactose is withdrawn from and returned to the diet, suggests that some metabolite of galactose accumulates in the cells of the renal tubules and has an inhibitory effect on the reabsorption of a number of substances. 

Urinary oxalate Some patients may develop increased levels of urinary oxalate following treatment. Exercise caution in patients with a history of hyperoxaluria or calcium oxalate nephrolithiasis. 

NephroHthiasis/UroHthiasis In addition to adequate hydration, medical management in patients who experience nephrolithiasis may include temporary interruption of therapy (eg, 1 to 3 days) or discontinuation of therapy. 

Nephrolithiasis/Urolithiasis Nephrolithiasis/Urolithiasis has occurred with indinavir. The frequency of nephrolithiasis is substantially higher in pediatric patients (29%) than in adult patients (9.3%). 

Adverse reactions occurring in at least 3% of patients include abdominal pain nausea diarrhea vomiting headache dizziness pruritus nephrolithiasis/urolithiasis back pain fever increased ALT, AST, and total serum bilirubin decreased neutrophils. 

Coriander Coriandrum sativum) Uses t Appetite, treat D, dyspep-sia, flatulence Action Stimulates gastric secretions, spasmolytic effects Available forms Tine 10-30 gtts PO OD Contra w/ PRG or lactation Notes/SE N/V, fatty liver tumors, allergic skin Rxns Interactions T Effects OF oral hypoglycemics EMS T Risk of photosensitivity Rxns may cause hypoglycemia Cranberry [Vaeeinium macreearpon) Uses Prevention UTI urinary deodorizer in urinary incontinence Actions Interferes w/ bacterial adherence to epithelial cells of the bladder Available forms Caps 300-500 mg PO bid-qid unsweetened juice 8-16 oz daily tine 3-5 mL or tincture 1/2-1 tsp up to 3X/d, tea 2-3 tsps of dried flowers/cup creams apply topically 2-3X/d PO SE D, irritation, nephrolithiasis if T urinary Ca oxalate Interactions T Effects OF warfarin ... 

Indinavir is associated with a dose-related risk of nephrolithiasis the risk is thereby increased by drug interactions that result in increased plasma concentrations. 

Uricosurics like probenecid, sulfinpyrasone and benzbromaron increase urate clearance and fractional excretion of filtered urate. They are used in underexcretors of urate. Uricosurics benefit patients with hyperuricemia, intact renal function and no history of nephrolithiasis. In tropical and subtropical climates where most of the Third World countries are situated, the prevalence of urolithiasis is >40%. The use of uricosurics is contraindicated in patients with a history of urolithiasis as the number and size of stones will be increased. Without an history of urolithiasis, uricosurics still should be applied with caution where the risk for dehydration is high. 

Indinavir (Crixivan) is a potent inhibitor of HIV reverse transcriptase. It produces the side effects common to aU protease inhibitors and also may produce nephrolithiasis, urolithiasis, and possibly renal insufficiency or renal failure. This problem occurs more fre-... 

Contraindications Concurrent use with terfenadine, cisapride, astemizole, triazolam, midazolam, pimozide, ergot derivatives nephrolithiasis... 

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