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Documente Profesional
Documente Cultură
Eritrocituria
Leucocituria
Clulas tubulares
Sedimento activo
Clulas epiteliales
Clulas transicionales
Cilindro hialino
Cilindro granuloso
Cilindro eritrocitario
Cristales de cistina
Cristales de oxalato
Cristales de urato
Cristales de sulfas
Sistema urinario
% (Canad)
44.7
4.4
6.1
16.2
14.9
18.2
17.2
Ac rico
10.4
9.9
Urato monosdico
5.7
3.0
4.8
0.2
Cistina
1.2
0.9
Xantina
0.5
0.6
2,8 dihidroxiadenina
0.4
0.3
Fosfato de magnesio
2.5
2.2
74.5
82.9
Hipercalciuria
Hiperoxaluria
Hipocitraturia
Hiperuricemia/hiperuricosuria
Acidosis tubular renal
Medicamentos
Alteraciones anatmicas del trayecto urinario
Infeccin de vas urinarias
Deshidratacion
Exploracin fsica
Estudios de laboratorio
Estudios de Gabinete
Sintomatologa.
Dolor sbito en fosa renal (Dolor tipo clico renal)
Dolor irradiado hacia el trayecto urinario hasta loa regin del
perin
Hematuria
Disuria
Sndrome febril
Polaquiria
Nauseas
Vmito
leo
Observacin del calculo en PSA (80%)
Nefrocalcinosis (HPT 1 o ATR)
Uropata obstructiva (TAC o US renal)
Urinarios:
Creatinina, Na, Ca, Ac rico, Examen de de orina, urocultivo, Oxalatos y
citratos.
HA TII
FRC
Calcio
Fsforo
HPT
1,24(OH)D3
Sricos
Calcio urinario
Ayuno
Restriccin de calcio
Carga de calcio
HPTP
1,25(OH)D3
Calcio urinario
<2 mg/kg/peso ideal (menos de 140 mg/da)
Oxalatos
<40 mgs/da
Citratos
> 350 mgs/da
uricosuria
< de 450 mg/da en mujeres, < de 600 mg/da en hombres
Sodio urinario
< de 100 mg/da
Fsforo
< de 1 grs/da
pH urinario
Entre 5.5 y 7.5
Causas de hiperoxaluria
Alteraciones en la sntesis de oxalatos y/o alteraciones enzimticos
Hiperoxalemia tipo I y tipo II
Deficiencia de piridoxina
Entrica
Absortiva
Gnero
Semejante
Femenino
Masculino
Oxalosis
Comn
Frecuente
Rara
Funcin renal
Potasio
A nivel urinario:
Calcio
Magnesio
N
N
Oxalato
Citrato
pH
Composicin del
lito
Ox de Ca
Ox de Ca y Ac.
Urico
Ox de Ca y
HP0Ca
Causas de hipocitraturia
Acidosis tubular distal
Completa o incompleta
Sx diarreico crnico
Mala absorcin intestinal de citrato
Uso de tiazidas
Elevado consumo de protenas
Elevado consumo de sal
Infeccin de vas urinaria
Idioptico
Hiperparatiroidismo
Enfermedades granulomatosas
Tirotoxicosis
Inmovilizacin
Tumores malignos
Medicamentos
Hipercalciuria idioptica
Urolitiasis.
Estruvita
Infecciones de vas urinaria
pH urianario alto
Cistina
Bajo volumen urinario
Incremento en la ingesta de aminocidos esenciales
(cistina, ornitina, lisina, glargina)
Alteraciones genticas del metabolismo
Staphylococo aureus
Micrococo varians
Corynebacterium
Peptoestreptococo
Bacilus sp
Gram negativos
Proteus
Flavobacterium
Brucela sp
Yersenia
Bordetella pertusis
Hongos
Criptococo
Rhadotorilla
Esporobolmices
Cndida humicola
Tricosporum cutaneum
Gota
-sndrome de lisis tumoral
Anemia hemoltica
Medicamentos
Errores congnitos del metabolismo
Sx de Lesch-Nyham, deficiencia de 6 frutuosa
Hipovolemia
Diarrea, baja ingesta de lquidos, prdida de lquidos por
otras vas
pH urinario bajo
Diurticos de asa
Anticidos
Acetazolamida
Teofilina
Glucocorticoides
Vitaminas D y C
Otros
Triamtireno, antivirales
Tratamiento:
Fase aguda
Recordar que el 90% de los clculos menores de 1 cm, se van a
expulsar mediante las siguientes medidas:
Analgsicos potentes con poder anti inflamatorio
Indometacina
Tratamiento:
Fase aguda
Si hay complicaciones realizar las siguientes medidas:
Internar al paciente para:
Analgsicos potentes endovenosos y antibiticos tambin endovenosos
Sobre hidratacin
Considerar realizar procedimientos de endourologa
Litotripsia endo urologica (litotriptor neumtico, pinzas fragmentadoras)
Canasteo
Tratamiento:
Fase crnica:
Identificar la causa
Vigilancia mdica estrecha
Si hay recada valorar estudios metablicos completos
Valorar riesgos de infecciones incluyendo micobacteriosis
Evaluar malformaciones de la va urinaria
Una vez establecido el diagnstico, dar el tratamiento
especfico
En un 10% de los casos, el paciente debe de ser manejado por
ms de 2 sub especialistas
Evitar complicaciones mayores que pongan en riesgo el
funcionamiento renal y la vida del paciente
Year
1970
1980
1990
2000
Rate (
155.1 (
183.7 (
144.0 (
105.0 (
s.e.) a
28.5)
29.3)
22.3)
16.8)
Women
Total
Cases
31
42
44
40
Rate ( s.e.) a
43.2 ( 14.0)
53.6 ( 13.8)
92.4 ( 16.3)
68.4 ( 12.3)
Cases
10
16
34
31
Rate ( s.e.) b
98.7 ( 15.7)
116.5 ( 15.8)
117.1 ( 13.6)
85.1 ( 10.2)
Cases
41
58
78
71
157
65.8 ( 7.0)
91
101.8 ( 6.6)
248
1980
1990
2000
41
58
78
71
18
32
41
62
(44
)
(55
)
(53
)
(87
)
% Calcium Oxalate
72.2
78.1
70.7
74.2
% Calcium Phosphate
22.2
12.5
29.3
17.7
% Uric Acid
5.6
9.4
8.1
Year
1970
1980
1990
2000
Rate (
189.0 (
229.7 (
171.6 (
125.9 (
s.e.) a
31.8)
32.8)
24.2)
18.4)
Women
Total
Cases
37
52
53
48
Rate ( s.e.) a
47.8 ( 4.8)
59.4 ( 14.2)
107.2 ( 17.4)
77.7 ( 13.2)
Cases
11
19
40
35
Rate (
116.8 (
142.2 (
138.1 (
100.1 (
s.e.) b
17.1)
17.5)
14.7)
11.0)
190
75.4 ( 7.5)
105
121.0 ( 7.2)
Cases
48
71
93
83
295
175
173
9a
9a,b
<0
72.8 15.9 ,
25.1 4.9a,b
89.9
10.1
52.0
86.9
31.8/57.3/11.0a,b
18.9/58.9/22.2a
32.8/45.2/22.0a
14.5/57.2/28.3a
1.7 1.0a,b
5.0 2.2a,b
<0
<0
0.9
0.4
0.4
0.1
<0
0.0
<0
<0
<0
<0
170
g
m2
nes% pts
s% pts
story of stones% pts
urrence% pts
% pts Low/Moderate/High
% pts Low/Moderate/High
% pts Low/Moderate/High
ke% pts Low/Moderate/High
a mol/dL GF
mol/dL GF
s, no. (%)
86.7 17.5
28.2 5.4
92.1
7.9
54.2
90.4
11.8/36.1/52.1
14.0/52.8/33.2
18.1/40.4/41.5
4.7/42.9/52.5
2.5 1.7
7.0 3.0
78.6 15
26.2 4.4a
89.5
10.5
57.6
91.5
14.2/60.8/25.0a
18.7/57.1/25.2
27.0/46.5/26.6a
7.9/55.8/36.3a
2.2 1.2a
6.0 2.2a
262 (73.6)
Kidney
a International
a,b 68, 22642273<0
153 (63.0)
0 (0)(2005)
TV mL
2081 918
1963 954
0.002
Effect
urinary
risk factors
pHof dietary modification
5.99 0.39 on5.94
0.41stone 0.01
Ca mmol/day
Ox mmol/day
Cit mmol/day
9.18 2.00
6.54 2.35
0.408 0.141 0.392 0.160
3.01 1.39
2.70 1.36
Mg mmol/day
P mmol/day
Na mmol/day
K mmol/day
UA mmol/day
SO4 mmol/day
NH4 mEq/day
Cr mmol/day
RSR CaOx
RSR Br
4.95 1.62
35.7 9.9
208 76
57.3 19.6
4.05 1.20
24.4 9.2
42.8 17.4
15.9 3.6
9.94 4.22
3.21 1.79
<0.0001
0.0635
<0.0001
4.14 1.49
<0.0001
31.5 10.4
<0.0001
125 64
<0.0001
53.6 21.8
0.0003
3.98 1.49
0.4
23.4 9.5
0.1
43.3 15.3
0.8
15.8 3.8
0.3
8.76 3.94
<0.0001
2.22 1.65
<0.0001
Kidney International (2005) 68, 22642273
TV mL
1795 852
1727 851
0.1
Effect
urinary
risk factors
pHof dietary modification
6.03 0.39 on5.97
0.44stone 0.02
Ca mmol/day
Ox mmol/day
Cit mmol/day
5.89 0.52
4.74 1.62
0.364 0.133 0.344 0.127
2.62 1.34
2.27 1.26
Mg mmol/day
P mmol/day
Na mmol/day
K mmol/day
UA mmol/day
SO4 mmol/day
NH4 mEq/day
Cr mmol/day
RSR CaOx
RSR Br
4.05 1.30
29.1 7.5
170 63
51.1 18.2
3.48 1.01
19.6 7
33.9 11.8
14.1 3.4
8.62 4.01
2.64 1.72
<0.0001
0.1
<0.0001
3.50 1.37
<0.0001
27.1 8.8
0.0003
108 50
<0.0001
45.3 18.5
<0.0001
3.32 1.20
0.02
20.3 10.1
0.2
40.8 15.8
0.0001
14.1 3.5
0.6
8.09 3.62
0.04
2.07 1.89
<0.0001
Kidney International (2005) 68, 22642273
TV mL
1581 694
1618 773
0.3
Effect
urinary
risk factors
pHof dietary modification
6.01 0.44 on5.96
0.43stone 0.04
Ca mmol/day
Ox mmol/day
Cit mmol/day
3.62 1.05
3.24 1.37
0.363 0.215 0.355 0.224
2.15 1.27
2.05 1.21
Mg mmol/day
P mmol/day
Na mmol/day
K mmol/day
UA mmol/day
SO4 mmol/day
NH4 mEq/day
Cr mmol/day
RSR CaOx
RSR Br
3.40 1.53
25.7 7.7
147 59
46.1 17.4
3.10 1.01
16.6 7.3
32.4 16.1
12.6 3.5
6.88 4.33
1.73 1.52
<0.0001
0.8
0.3
3.18 1.25
0.002
23.7 7.9
<0.0001
102 51
<0.0001
43.3 17.3
0.002
3.08 1.18
0.9
17.3 7.9
0.1
34.4 13.2
0.1
13.0 3.8
0.3
6.57 3.58
0.09
1.43 1.35
<0.0001
Kidney International (2005) 68, 22642273
ersons
without
nephrolithiaisis
(N of
= 318,956)
Total Persons
nephrolithiais
Direct
and
indirect costs
nephrolithiasis
in anwith
employed
Total
Medical
R
population: Opportunity for disease management?
3,038
$6,532
$5,381
$1
2,809
3,278
3,123
$6,114
$7,093
$6,525
$5,086
$5,777
$5,375
$1
$1
$1
2,808
3,331
$6,302
$6,825
$5,227
$5,578
$1
$1
2,948
2,962
3,152
$6,442
$6,456
$6,647
$5,367
$5,369
$5,402
$1
$1
$1
2,978
$6,472
$5,351
$1
ersons
without
nephrolithiaisis
(N of
= 318,956)
Total Persons
nephrolithiais
Direct
and
indirect costs
nephrolithiasis
in anwith
employed
Total
Medical
R
population: Opportunity for disease management?
3,038
$6,532
$5,381
$1
2,809
3,278
3,123
$6,114
$7,093
$6,525
$5,086
$5,777
$5,375
$1
$1
$1
2,808
3,331
$6,302
$6,825
$5,227
$5,578
$1
$1
2,948
2,962
3,152
$6,442
$6,456
$6,647
$5,367
$5,369
$5,402
$1
$1
$1
2,978
$6,472
$5,351
$1
Mean nu
1.26
1.00
1.22
1.12
Number of personsa
30.0%
Inpatient care
Ou
r of hospitalizationsa Average work absence (hours) Number of outpatient vis
47.9 (30.9-64.9)
2,373
Inpatient care
Ou
r of hospitalizationsa Average work absence (hours) Number of outpatient vis
47.9 (30.9-64.9)
2,373
Diabetes -
P value
NHS I
Number %
Age years b
1473 (1.9%)
48.6
74,266 (98.1%)
46.3
<0.001
BMI kg/m2 b
Current thiazide use
Kidney stone history
28.1
329 (22.3%)
64 (4.3%)
24.3
7382 (9.9%)
2029 (2.7%)
<0.001
<0.001
<0.001
NHS II
Number %
Age years b
949 (1.0%)
37.6
94,485 (99.0%)
36.1
<0.001
2b
Diabetes
Diabetes +
NHS II
Diabetes
Diabetes +
HPFS
Diabetes
Diabetes +
1.00 (reference)
1.55 (1.20, 1.99)
1.00 (reference)
1.38 (1.06, 1.79)
1.00 (reference)
1.00 (reference)
1.00 (reference)
1.00 (reference)
Diabetes 1,371,080
Diabetes + 65,566
1578
109
Diabetes 824,076
1491
Diabetes + 12,291
40
Diabetes 450,984
1426
Diabetes + 21,676
44
1.00 (reference)
1.45 (1.20, 1.77)
NHS II
1.00 (reference)
1.86 (1.36, 2.56)
HPFS
1.00 (reference)
0.76 (0.56, 1.03)
1.00 (reference)
1.29 (1.05, 1.58)
1.00 (reference)
1.60 (1.16, 2.21)
1.00 (reference)
Stones
Stones +
NHS II
Stones
Stones +
HPFS
Stones
Stones +
1,522,293
64,590
4005
295
1.00 (reference)
1.65 (1.47, 1.86)
1.00 (reference)
1.33 (1.18, 1.50)
988,262
712
1.00 (reference)
1.00 (reference)
44,290
73
399,935
1157
1.00 (reference)
1.00 (reference)
44,373
218
ry sodium mmol/24h
130
5.3
146
5.7
189
7.7c
155
Urinary
calcium
a determinant
bone
mineral
density
ry NTx nmol
BCE/mmol
Cris 50
5.3 (45) 45of 3.0
(53)
46 2.2
(48) in47
3.
2.1
0.00 0
0.00 0
2372 3
um intake mmol/24h
n g/1000 kcal
g/1000 kcal
hydrate g/1000 kcal
22.0 0.70
37.8 0.46
32.1 0.49
132.2 1.67
22.1 0.85
37.0 0.44
32.5 0.55
126.8 1.64
21.1 0.8
38.0 0.47
32.8 0.53
127.1 1.62
22.5 0
37.6 0
32.5 0
128.7
ears
98
72
98
66
97
60
293
66 0.9
kg/m2
a calcium mmol/L
a PTH pg/mL
26.5
2.36
26.4
n
1.4
0.44 26.7
0.009 2.35
1.29 22.9
1.7
1.6e
0.39
27.6 0.47
26.9 0
0.008 2.37 0.008
2.36 0
f
1.10
21.9 1.11
23.8 0
Kidney International
(2005) 67, 20062014
e years
MI kg/m2
sma calcium mmol/L
sma PTH pg/mL
Tertile 1
80
76 0.9
Tertile 2
74
73 0.6b
26.6
2.31
23.5
27.3
2.34
22.5
0.22
0.009
1.28
55.5 3.55
1.56 0.072
127 6.1
50 6.3 (35)
0.22 0.120
-0.03 0.135
Tertile 3
65
71 0.6a
0.35 27.4
0.010 2.37
1.11 19.4
56.3 3.37
3.36 0.058
147 6.8
46 3.5 (37)
-0.0 0.117
0.01 0.104
0.40
0.009c
1.0d
66.9 3.71
6.13 0.257
186 10.2e
48 2.8 (33)
-0.29 0.127f
-0.12 0.130
All tertiles
219
74 0.4
27.1
2.34
22.0
0.22
0.006
0.68
59.1 2.07
3.52 0.150
151 4.7
48 2.6 (10
-0.01 0.07
-0.01 0.07
R 2 change R 2 change P B
Creatinine clearance
Urinary sodium
Plasma calcium
Trabecular BMD z-score
Logarithm of plasma 25(OH)D
Women
Urinary sodium
Creatinine clearance
0.111
0.043
0.029
0.025
0.013
0.001
0.001
0.002
0.003
0.035
0.017
0.006
0.984
-0.352
1.131
0.0001
0.001
0.003
0.004
0.035
0.199
0.001
0.014 0.0001
0.031
0.001
0.013 0.001
s, daily intake
fruits
vegetables on
Dieturinary
without fruits
The effectDiet
of with
fruits
andand
vegetables
stoneand vege
100 g
200 g
80 g
meat or fish
arella or soft cheese
esan cheese
salt
100 g
100 g
10 g
10 g
20 g
50 g
0
100 g
400 g
300 g
oil
arose
e juice
mixed fruita
mixed vegetablesb
risk factors
100 g
200 g
100 g
100 g
100 g
30 g
10 g
20 g
45 g
40 g
0
0
0
Kidney International (2004) 66, 24022410
ients, daily intake Diet with fruits and vegetables Diet without fruits and veget
ohydrates g
99
252
99
252
um mmol
ride mmol
sium mmol
216
250
81
218
254
30
um mmol
phorus mmol
nesium mmol
ate mmol
g
r from foods g
cid load mmol a
22.7
40.0
10.2
3.72
21
1006
47.6
23.4
38.5
7.1
0.20
10
305
Kidney
76.7International (2004) 66, 24022410
37.6 (11.0)
16.4 (5.9)
ol/day
23.4 (5.5)
16.5 (7.5)
20.2 (6.7)
16.4 (8.5)
ol/day
4.01 (0.75)
2.83 (1.32)
203 (32)
2.95 (0.60)
2.40 (1.26)
221 (56)
ay
ay
day
ay
137 (41)
2.71 (0.64)
1.86 (0.61)
2.70 (1.05)
1.93 (1.23)
0.35 (0.07)
0.24 (0.08)
167 (47)
2.66 (0.56)
2.13 (0.93)
1.52 (0.80)
1.30 (1.07)
0.24 (0.06)
Kidney
International
0.20
(0.11) (2004) 66, 24022410
28.7 (11.2)
27.9 (10.8)
ol/day
20.2 (6.8)
18.4 (7.6)
21.8 (7.4)
11.7 (5.0)
ol/day
2.73 (0.93)
2.60 (1.43)
163 (55)
3.35 (0.89)
1.75 (0.55)
170 (59)
ay
ay
day
ay
153 (75)
2.92 (0.85)
2.75 (1.23)
1.17 (0.30)
1.10 (0.49)
0.34 (0.17)
0.31 (0.17)
89 (29)
3.22 (1.16)
1.67 (0.58)
1.97 (0.64)
1.09 (0.51)
0.33 (0.17)
Kidney International
(2004) 66, 24022410
0.17 (0.08)