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Nephrolithiasis Teaching Module 2008-9 By  Tejas Desai, MD Darina Stankeyeva, MD Arlene Chapman, MD James Bailey, MD Division of Nephrology and Hypertension Emory University School of Medicine
Module Format This module will present learning material on Nephrolithiasis using interactive features to enhance your experience. There are two (2) ways you can view this teaching module: 1) You can view the module directly through the Internet (no downloading required), or 2) You can download the module to your computer. The method you choose to view this module will determine the interactive features that are available to you.
If you view the module  directly through the Internet , you will  not  be able to navigate through the presentation in a non-linear fashion. That is, you will  not  be able to click on intramodular links. If you choose to  download the module  to your computer, you will need Microsoft PowerPoint 2003 or greater (Mac or PC). All intramodular links will be available to you, allowing for  non-linear navigation through the module. Regardless of which viewing preference you choose, all  References  will be available to you. Continue onto the next slide to learn about the module’s features and how you can use them. You can  skip this introduction  and jump straight to the content (if you are viewing the module on your computer).  Otherwise, you can continue by clicking the arrow. Module Format (continued)
Features  (for downloaded version only) Reference Table of Contents:  This is a nested TOC that allows you to jump from one section (and subsection) to another.  Clicking on the main section (e.g., Pathogenesis) will display the subsections for that area of study. References:  Moving your cursor over this area will display the citation from which the material was obtained (downloaded version only).  Clicking the word “Reference” will load the primary source for your review.  We encourage that you read the primary sources to formulate your own perspectives and develop your skills in critically evaluating scientific articles. Definitions:  throughout the module, terms will be  highlighted   to indicate that there is an associated definition.  Place your cursor (arrow) over the term to learn its meaning. Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Features  (for Internet version only) Web-browsing:  Links will take you to WWW sites.  Please disable pop-up blockers to take advantage of this feature. Navigation:  Linear navigation is active in the Internet version.  Non-linear navigation can be performed by clicking the links within the presentation (for downloadable version only). For those using the Internet version, you can access the primary reference by clicking on the graphs, tables, or key words (highlighted) for each slide. Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Epidemiology Table of Contents Epidemiology Race Geography Gender Body Size Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones 1988-1994 1976-1980 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology:  Race Table of Contents Epidemiology Race  Geography Gender Body Size Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones Reference ,[object Object],[object Object],[object Object],1988-1994 1976-1980
Epidemiology:  Geography Reference ,[object Object],Table of Contents Epidemiology Race Geography Gender Body Size Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Epidemiology:  Geography   (cont’d) Reference ,[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Race Geography Gender Body Size Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Epidemiology:  Gender Reference ,[object Object],Table of Contents Epidemiology Race Geography Gender Body Size Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones Males Females
Epidemiology:  Body Size Reference ,[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Race Geography Gender Body Size Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Pathogenesis Table of Contents Epidemiology Pathogenesis Saturation Nucleation Inhibitors Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathogenesis:  Saturation Table of Contents Epidemiology Pathogenesis Saturation Metastable ULM Normal Urine Nucleation Inhibitors Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones Reference ,[object Object],[object Object],[object Object],[object Object],No crystals in solution because we have a low solubility product
Pathogenesis:  Saturation   (cont’d) Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Saturation Metastable ULM Normal Urine Nucleation Inhibitors Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones A metastable solution + a pre-existing surface or crystal A precipitated solution
Pathogenesis:  Saturation   (cont’d) Reference ,[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Saturation Metastable ULM Normal Urine Nucleation Inhibitors Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones Y-axis:  SP for Calcium Oxalate
Pathogenesis:  Saturation   (cont’d) ,[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Saturation Metastable ULM Normal Urine Nucleation Inhibitors Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Pathogenesis:  Nucleation Table of Contents Epidemiology Pathogenesis Saturation Nucleation Fixed Particle Theory Inhibitors Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reference
Pathogenesis:  Nucleation   (cont’d) Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Saturation Nucleation Fixed Particle Theory Inhibitors Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Pathogenesis:  Inhibitors Table of Contents Epidemiology Pathogenesis Saturation Nucleation Inhibitors Mg 2+  and Citrate Osteopontin Tamm-Horsfall P Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reference
Pathogenesis:  Inhibitors   (cont’d) Table of Contents Epidemiology Pathogenesis Saturation Nucleation Inhibitors Mg 2+  and Citrate Osteopontin Tamm-Horsfall P Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object]
Pathogenesis:  Inhibitors   (cont’d) Table of Contents Epidemiology Pathogenesis Saturation Nucleation Inhibitors Mg 2+  and Citrate Osteopontin Tamm-Horsfall P Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],Legend: -  inhibitory effects of osteopontin +  stimulatory effects of osteopontin COM  calcium oxalate monohydrate COD  calcium oxalate dihydrate
Pathogenesis:  Inhibitors   (cont’d) ,[object Object],[object Object],[object Object],Reference Table of Contents Epidemiology Pathogenesis Saturation Nucleation Inhibitors Mg 2+  and Citrate   Osteopontin Tamm-Horsfall P Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Clinical Manifestations Reference Table of Contents Epidemiology Pathogenesis Clinical Manifestations LPHS Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations  (cont’d) Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations LPHS Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Evaluation Reference Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation 1st-time Stone Formers Data Stone Analysis ( 1 ,   2) General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation  (cont’d) Reference Men Women Recurrence  Free  Rate Recurrence  Free  Rate Uric Acid + Calcium Cystine Struvite Uric Acid or Calcium Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation 1st-time Stone Formers Data Stone Analysis ( 1 ,   2) General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Evaluation  (cont’d) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reference Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation 1st-time Stone Formers Data Stone Analysis ( 1 ,   2) General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Evaluation  (cont’d) Reference ,[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation 1st-time Stone Formers Data Stone Analysis (1 ,   2) General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Evaluation  (cont’d) Reference ,[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation 1st-time Stone Formers Data Stone Analysis  (1 ,   2) General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
General Therapy Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Fluid Intake (1 ,   2) Sodium Intake Animal Protein Calcium Intake (1 ,  2) Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Therapy -  Fluid Reference ,[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Fluid Intake (1 ,   2) Sodium Intake Animal Protein Calcium Intake (1 , 2) Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
General Therapy -  Fluid   (cont’d) Reference ,[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Fluid Intake  (1 ,   2) Sodium Intake Animal Protein Calcium Intake (1 , 2) Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
General Therapy -  Sodium ,[object Object],[object Object],[object Object],[object Object],Reference Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Fluid Intake (1 ,   2) Sodium Intake Animal Protein Calcium Intake (1 ,  2) Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
General Therapy -  Protein Reference ,[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Fluid Intake (1 ,   2) Sodium Intake Animal Protein Calcium Intake (1 ,  2) Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
General Therapy -  Calcium Reference ,[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Fluid Intake (1 ,   2) Sodium Intake Animal Protein Calcium Intake (1 ,  2) Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
General Therapy -  Calcium   (cont’d) Reference Both groups of patients were told to increase oral water intake and decrease oxalate intake ,[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Fluid Intake (1 ,   2) Sodium Intake Animal Protein Calcium Intake  (1,   2) Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology ( 1 , 2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 ,  2) Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],Reference (Extracellular pool)
Calcium Stones -  Physiology Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 , 2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 ,  2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Physiology   (cont’d) Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology  (1 , 2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 ,  2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Calcium Oxalate Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology ( 1 , 2) Idiopathic Ca-Ox Stones (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 ,  2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Calcium Oxalate   (cont’d) ,[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology ( 1 , 2) Idiopathic Ca-Ox Stones (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 ,  2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  PTH Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology ( 1 , 2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 ,  2) Uric Acid Stones Struvite Stones Cystine Stones ,[object Object],[object Object]
Calcium Stones -  Hyperoxaluria Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones Reference ,[object Object],[object Object]
Calcium Stones -  Hyperoxaluria - Intestinal Handling ,[object Object],[object Object],[object Object],[object Object],Reference Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Hyperoxaluria - Renal Handling Reference ,[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Enteric Hyperoxaluria Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Enteric Hyperoxaluria (cont’d) Reference ,[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Hypocitraturia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reference Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Hypocitraturia (cont’d) ,[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia  ( 1,   2) Hyperuricosuria Calcium Phosphate   (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Hyperuricosuria Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate   (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Calcium Phosphate Reference ,[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate (1 , 2) Uric Acid Stones Struvite Stones Cystine Stones
Calcium Stones -  Calcium Phosphate (cont’d) ,[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Basic Physiology (1 ,  2) Idiopathic Ca-Ox Stones   (1 ,  2) 1* Hyperparathyroidism Hyperoxaluria Intestinal Handling Renal Handling Enteric Hyperoxaluria Treatment Hypocitraturia (1 ,  2) Hyperuricosuria Calcium Phosphate  (1,   2) Uric Acid Stones Struvite Stones Cystine Stones
Uric Acid Stones Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Urine pH (1 ,   2,   3) Diagnosis & Eval. Treatment Struvite Stones Cystine Stones Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Uric Acid Stones -  Urine pH  Reference ,[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Urine pH (1 ,   2,   3) Diagnosis & Eval. Treatment Struvite Stones Cystine Stones Limit of solubility of uric acid
Uric Acid Stones -  Urine pH (cont’d) Reference ,[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Urine pH  (1 ,   2 ,   3) Diagnosis & Eval. Treatment Struvite Stones Cystine Stones
Uric Acid Stones -  Urine pH (cont’d) Reference ,[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Urine pH  (1 ,   2,   3) Diagnosis & Eval. Treatment Struvite Stones Cystine Stones
Uric Acid Stones -  Diagnosis and Evaluation  Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Urine pH (1 ,   2,   3) Diagnosis & Eval. Treatment Struvite Stones Cystine Stones
Uric Acid Stones –  Treatment  Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Urine pH (1 ,   2 , 3 ) Diagnosis & Eval. Treatment Struvite Stones Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reference
Struvite Stones Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Pathogenesis Urease Organisms Therapy Cystine Stones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reference
Struvite Stones -  Pathogenesis Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Pathogenesis Urease Organisms Therapy Cystine Stones Reference ,[object Object],Urea + Urease + H 2 O + Mg 2+  ( found in urine normally ) + PO 4 3-  (found in urine normally) Struvite
Struvite Stones  –  Urease Organisms Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Pathogenesis Urease Organisms Therapy Cystine Stones Reference ,[object Object],[object Object],[object Object],[object Object]
Struvite Stones  –  Therapy Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Pathogenesis Urease Organisms Therapy Cystine Stones Reference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cystine Stones Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones Reference ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you for viewing the 2008-9 teaching module in  Nephrolithiasis. Please complete the post-module examination  and the brief questionnaire.  The questionnaire will be used to improve the design and  content of future teaching modules for  the Emory Renal Fellowship program. Both can be found in the same folder as this module.
 

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Nephrolithiasis Teaching Module (2008-9)

  • 1. Nephrolithiasis Teaching Module 2008-9 By Tejas Desai, MD Darina Stankeyeva, MD Arlene Chapman, MD James Bailey, MD Division of Nephrology and Hypertension Emory University School of Medicine
  • 2. Module Format This module will present learning material on Nephrolithiasis using interactive features to enhance your experience. There are two (2) ways you can view this teaching module: 1) You can view the module directly through the Internet (no downloading required), or 2) You can download the module to your computer. The method you choose to view this module will determine the interactive features that are available to you.
  • 3. If you view the module directly through the Internet , you will not be able to navigate through the presentation in a non-linear fashion. That is, you will not be able to click on intramodular links. If you choose to download the module to your computer, you will need Microsoft PowerPoint 2003 or greater (Mac or PC). All intramodular links will be available to you, allowing for non-linear navigation through the module. Regardless of which viewing preference you choose, all References will be available to you. Continue onto the next slide to learn about the module’s features and how you can use them. You can skip this introduction and jump straight to the content (if you are viewing the module on your computer). Otherwise, you can continue by clicking the arrow. Module Format (continued)
  • 4. Features (for downloaded version only) Reference Table of Contents: This is a nested TOC that allows you to jump from one section (and subsection) to another. Clicking on the main section (e.g., Pathogenesis) will display the subsections for that area of study. References: Moving your cursor over this area will display the citation from which the material was obtained (downloaded version only). Clicking the word “Reference” will load the primary source for your review. We encourage that you read the primary sources to formulate your own perspectives and develop your skills in critically evaluating scientific articles. Definitions: throughout the module, terms will be highlighted to indicate that there is an associated definition. Place your cursor (arrow) over the term to learn its meaning. Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
  • 5. Features (for Internet version only) Web-browsing: Links will take you to WWW sites. Please disable pop-up blockers to take advantage of this feature. Navigation: Linear navigation is active in the Internet version. Non-linear navigation can be performed by clicking the links within the presentation (for downloadable version only). For those using the Internet version, you can access the primary reference by clicking on the graphs, tables, or key words (highlighted) for each slide. Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
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  • 26. Evaluation (cont’d) Reference Men Women Recurrence Free Rate Recurrence Free Rate Uric Acid + Calcium Cystine Struvite Uric Acid or Calcium Table of Contents Epidemiology Pathogenesis Clinical Manifestations Evaluation 1st-time Stone Formers Data Stone Analysis ( 1 , 2) General Therapy Calcium Stones Uric Acid Stones Struvite Stones Cystine Stones
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  • 64. Thank you for viewing the 2008-9 teaching module in Nephrolithiasis. Please complete the post-module examination and the brief questionnaire. The questionnaire will be used to improve the design and content of future teaching modules for the Emory Renal Fellowship program. Both can be found in the same folder as this module.
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