KIDNEY STONE VARIETIES

A. Calcium calculi
B. Non-calcium calculi
1) Struvite
2) Uric acid
3) Cystine
4) Xanthine
5) Indinavir
6) Rare
- Silicate stones
Associated with long term of antacids containing silica
- Triamterene stones
Associated with antihypertensive medications containing triamterene, such as
Dyazide
Radiolucent
Discontinuing the medications eliminates stone recurrences
- Glafenine & antrafenine may also become stone constituents

Struvite (consists of Uric acid Cystine Xanthine

MAP)
Frequenc 10-15% 10-15% <1% <1%
y Mostly in women Mostly in men
Clinical Neurogenic bladder, other Gout, DM, chronic - Renal tubular def
RF anatomic abnormality diarrheal disease, rapid
weight loss & cytotoxic
drugs usage
Urinary urine pH, urease (+) urine uric acid, Inherited disorder
RF UTI low urine pH/volume
Causes & Infection stones Defect in renal NH4+ Secondary to inborn Secondary to
mechanis associated with urea- secretion error of metabolism congenital deficie
m splitting organisms Chronic metabolic (genetic defects of of xanthine
Proteus, Pseudomonas, acidosis chromosome 19q13) dehydrogenase
Klebsiella, Staphylococci urinary uric acid level (catalyzes oxidatio
& Mycoplasma due to dehydration & abnormal intestinal hypoxanthine
[NH4+] derived from excess purine intake mucosal absorption & xanthine &
USO renal tubular absorption xanthine uric a
of dibasic amino acids
alkaline urine (>7.19) (cystine, lysine, arginine)
will cause MAP crystals
 NON-CALCIUM CALCULI

to precipitate

Crystal Coffin-lid Diamond, rhomboid Hexagonal with amber

shape colour
X-ray Radiopaque, Radiolucent, Faintly opaque, ground Radiolucent,
findings staghorns common staghorns possible glass, smooth-edged tannish yellow sto
stone.
May present as single,
multiple or staghorn
configured stones.
D(x) KUB radiograph/renal Acidic urine (<5.5) Cystine lithiasis is the
tools/ ultrasound only manifestation
Family history of kidney
stones
Cystinuria

Managem Culture-specific Maintain urine volume fluid intake (>3L/day) Based on symptom
ent antibiotics can reduce >2L/day & urine pH & urinary alkalinization evidence of rena
urease levels >6.0 Penicillamine urinary obstruction
Acetohydroxamic acid Reduce dietary cystine levels has Prophylaxis high
MOA : inhibits the purines/administration many SE intake & urinary
action of bacterial of allopurinol Mercaptopropionylglycin alkalinization
urease uric acid excretion e form soluble complex Stone reoccurrence
Alkalinization with oral with cystine stone trial of allopurino
pH of urine sodium bicarbonate, formation purine restricted
potassium citrate or IV Surgery SWL is appropriate
likelihood to 1/6 normal sodium
precipitate lactate may dissolve
calculi.

Absorptive Resorptive Renal-induced Hyperuricosuric Hyperoxaluric Hypocitratu

hypercalciuric hypercalciuric hypercalciuric calcium calcium nephro
nephrolithiasis nephrolithiasis nephrolithiasis nephrolithiasis nephrolithiasis
y Secondary to
calcium absorption
from small bowel
(jejunum)
sis calcium filtration
from glomerulus

Suppression of PTH

tubular
reabsorption of
calcium

Hypercalciuria
 (>4mg/kg)
Type I (15%)
- Independent of diet
- Ca level even in
calcium-restricted
diet
Type II
- Dietary
dependent
- Calcium returns
to normal on
calcium-
restricted diet
Type III (5%)
- Due to a
phosphate renal
leak
serum
phosphate

synthesis of 1,25-
dihydroxyvitamin D

absorption of
phosphate and
calcium (small
bowel)
renal excretion of
calcium
ent
Renal staghorn configured calculi

(branched with stones occupying the renal pelvis & at least to renal infundibula)