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  #1  
Old 08-04-2012
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Kidney Calcium Oxalate Stone Management!

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
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Old 08-04-2012
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Answer A thiazide diuretics decreases renal excretion of calcium..Hence decreases chance of nephrolithiasis..

Next step is to work up for Idiopathic hypercalcinuria...
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Old 08-04-2012
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A
prevention for calcium oxalate stone is with thiazide "most appropriately"
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Old 08-04-2012
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the first thing we do to prevent stones is increase water consumption right?
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Old 08-04-2012
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Quote:
Originally Posted by sonu.agarwall View Post
the first thing we do to prevent stones is increase water consumption right?
yes absolutely correct ....... increase fluid intake to greater than 2L / day ....
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Old 08-04-2012
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I'd say E)
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Old 08-05-2012
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Quote:
Originally Posted by stfidel View Post
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


Explanation:
The correct answer is A.
The composition of the stone is the most important component in designing therapy
to prevent future events of nephrolithiasis. Calcium stones account for approximately
80% of all stones. Hypercalciuria is usually present and may be idiopathic
or secondary to some other cause. Calcium stones may also precipitate around
a uric acid nidus, even in patients in whom hypercalciuria is not present.
If dietary measures are not effective in decreasing calciuria, then a thiazide
diuretic may be utilized to increase calcium reabsorption by the kidney.
Initiation of loop diuretic therapy (choice B) is contraindicated, as loop diuretics promote hypercalciuria.
Initiation of allopurinol therapy (choice C) is indicated in the treatment of uric acid stones or when hyperuricosuria is present with calcium stones.
Maintenance of an alkaline urine (choice D) is only useful if the patient also has hyperuricosuria.
Maintenance of large urine volumes via copious water consumption (choice E) is recommended to all acute stone patients but has limited efficacy in preventing recurrence of disease.
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