The patient was started Vitamin B6, potassium citrate and lithotriptics. He was advised to have a moderate calcium diet and avoid oxalate, VIT-C and fatty food. Three months later, the patient had gradual improvement with normalization of his laboratory abnormalities.
Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
26 Comments
Marwa Alm
– 24hrs urinary profile (Na, K, Ca, Pi, uric a, oxalate, Cr, volume, PH),
– complete serum metabolic panel, VBG
– PTH, vitamin D, ALP,
– Stone analysis
1. Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers. Analysis of the stone is an essential part of the evaluation of patients with established nephrolithiasis. The complete metabolic evaluation for nephrolithiasis consists of both blood and urine testing, including at least two 24-hour urine collections. In each 24-hour urine collection, the urine volume, pH, and excretion of calcium, uric acid, citrate, oxalate, sodium, potassium and creatinine (to assess the completeness of the collection) should be measured. Serum calcium, uric acid, creatinine and PTH should be measured to detect any metabolic abnormality.
Suggest an approach to the metabolic evaluation of uncomplicated calcium stone formers.
Detailed dietary and drug history
Family history of stone forming
Any history of ESKD and hemodialysis
Any history of death due to renal failure
Complete metabolic screen
Stone analysis
24hr urinary measurements of ca , oxalate,p, citrate,cystine , creatinine.
Genetic study to exclude hyperoxaluria and cystinuria.
Do a 24-hour urine collection for urinary calcium, uric acid, citrate, oxalate and phosphate
Do a thorough medical interrogation, specifically looking for Hyperuricaemia, renal tubular acidosis, Parathyroid disease and Repeated urinary tract infections
Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
Medical evaluation should identify patients with high risk for recurrent stone disease. Underlying medical disorders, such as gout, renal tubular acidosis, hyperoxaluria, hyperparathyroidism, urinary-tract infections,cystinuria, and hyperuricosuric hypercalciuria, must be identified.
urine analysis.
follow s. calcium, phosphorus, PTH, and vit D.
24-hour urinary calcium, oxalate, phosphate, urate, and citrate.
S. Electrolyte
25 OH vitamin D, alkaline phosphotase, s. Mg, PTH, BGA , chest x-ray
US of renal system
24 hrs Urine Ca, phosphorous, citrate, oxalate, Mg, creatinine
Medical evaluation include Urine analysis, monitoring of 24h Urin level of calcium , oxalate, citrate, urate , phosphate, PH and urin volume and measurment of iPTH, calcium , phosphate and uric acid and vitamin D in Serum.
In stone former, we need to encourage enough fluid intake low in sodium. Uric acid stones are managed with hydration and uricosuric drugs like allopurinol. Patients with hyperoxaluria are encouraged to consume low salt enough after avoidance of supplements like vitamin C and some nutrients. We need to ask for level of Ca/P7PTH, uric acid, oxalate, and citrate and 24 hours for calcium ric acid, oxalate and citrate. Patients who have obstructive stones should be consulted with urologists.
Suggest an approach to the metabolic evaluation of uncomplicated calcium stone formers.
medication and diet history
total serum calcium and ionized
urine analysis and PH
24-hour urinary calcium, oxalate, uric acid, and citrate
iPTH, 25(OH) Vit-D
Calcium /creatinine
Serum PH, HCO3
Suggest an approach to the metabolic evaluation of uncomplicated calcium stone formers.
Medical evaluation should identify patients with a high risk for recurrent stone disease. Underlying medical disorders, such as gout, renal tubular acidosis, hyperoxaluria, hyperparathyroidism, urinary tract infections, cystinuria, and hyperuricosuria hypercalciuria, must be identified.
Urine analysis.
Follow s. calcium, phosphorus, PTH, and vit D.
24-hour urinary calcium, oxalate, phosphate, urate, and citrate.
Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
Medical evaluation should identify patients with high risk for recurrent stone disease. Underlying medical disorders, such as gout, renal tubular acidosis, hyperoxaluria, hyperparathyroidism, urinary-tract infections, cystinuria, and hyperuricosuric hypercalciuria, must be identified.
urine analysis.
follow s. calcium, phosphorus, PTH, and vit D.
24-hour urinary calcium, oxalate, phosphate, urate, and citrate.
– 24hrs urinary profile (Na, K, Ca, Pi, uric a, oxalate, Cr, volume, PH),
– complete serum metabolic panel, VBG
– PTH, vitamin D, ALP,
– Stone analysis
Renal profile
24 urine electrolyte
stone analysis
24 hr urine two collection
urine volume /ph citratre/oxalate/calcium/na/k /creatinine
Serum Calcium/Phosphate/PTH/Vitamin D
metabolic evaluation of un complicated calcium stones formers
cbc, calcium , uric acid , pth ,rnal function , citrate
Good job dear doctors.
1. Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
Analysis of the stone is an essential part of the evaluation of patients with established nephrolithiasis. The complete metabolic evaluation for nephrolithiasis consists of both blood and urine testing, including at least two 24-hour urine collections. In each 24-hour urine collection, the urine volume, pH, and excretion of calcium, uric acid, citrate, oxalate, sodium, potassium and creatinine (to assess the completeness of the collection) should be measured. Serum calcium, uric acid, creatinine and PTH should be measured to detect any metabolic abnormality.
Suggest an approach to the metabolic evaluation of uncomplicated calcium stone formers.
Detailed dietary and drug history
Family history of stone forming
Any history of ESKD and hemodialysis
Any history of death due to renal failure
Complete metabolic screen
Stone analysis
24hr urinary measurements of ca , oxalate,p, citrate,cystine , creatinine.
Genetic study to exclude hyperoxaluria and cystinuria.
BGA to rule out RTA
Suggestions were 24 h urine ca ,oxalate ,citrate evaluation,renal function test,serum uric acid
-SCa ,S.po4 ,PTH, serum mg
us KUB /CT KUB
Approach
Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
PATIENT NEEDS DIET CONTROL , NEEDS FOR 24 HRS URINE CALCIUM , URIC ACID , OXALATE REGULLARLY , INCREASE FLUIED INTAKE AND REGULLAR FOLLOW UP
-24 h urine ca ,oxalate ,citrate
-S Cr, B urea ,SUA
-SCa ,S.po4 ,S.mg
-Vd, PTH
us KUB /CT KUB
S. Electrolyte
25 OH vitamin D, alkaline phosphotase, s. Mg, PTH, BGA , chest x-ray
US of renal system
24 hrs Urine Ca, phosphorous, citrate, oxalate, Mg, creatinine
Metabolic plan
Medical evaluation include Urine analysis, monitoring of 24h Urin level of calcium , oxalate, citrate, urate , phosphate, PH and urin volume and measurment of iPTH, calcium , phosphate and uric acid and vitamin D in Serum.
In stone former, we need to encourage enough fluid intake low in sodium. Uric acid stones are managed with hydration and uricosuric drugs like allopurinol. Patients with hyperoxaluria are encouraged to consume low salt enough after avoidance of supplements like vitamin C and some nutrients. We need to ask for level of Ca/P7PTH, uric acid, oxalate, and citrate and 24 hours for calcium ric acid, oxalate and citrate. Patients who have obstructive stones should be consulted with urologists.
medication and diet history
total serum calcium and ionized
urine analysis and PH
24-hour urinary calcium, oxalate, uric acid, and citrate
iPTH, 25(OH) Vit-D
Calcium /creatinine
Serum PH, HCO3
1. Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.