On a run and saw this. #hyponatremia #SCM16

insulin resistance associated with impaired ammoniagenesis. That is why obesity leads to low urine pH and increased uric acid stones #scm16

Take a look at the ss CaP. Improved with arlkalinization and then thiazide diuretic #SCM16

Alkalinizing calcium phosphate should be a no no but doesn't look like it is. #scm16

Aggregation and agglomeration is not part of supersaturation #scm16

pH dependent stones calcium phosphate and uric acid stones. #SCM16

Stone type by age. #SCM16

No RCT data on calcium phosphate stones, lost in the mass of calcium oxalate stones #scm16

Lancet MET study 2/2 Patients perception of pain is not a good measure of passing. Stone could just reposition and pain goes away. #scm16

MET Lancet study: randomized and no one was re-imaged. Outcome was a month later. #scm16

Did everyone wish @HecmagsMD a happy birthday yesterday? I think he turned 21. #scm16

Stones are a systemic disease. He is skeptical that data correlating CKD to lithotripsy is causal. #scm16

Percutaneous approach. #SCM16

Randall's plaque. Sweet! #SCM16

ureteroscopy 1.5-2 cm. minimally invasive. More effective than lithotripsy #scm16

Passing stones related to position and size of stone. #SCM16 look at his position on MET.

pain of renal origin cannot be provoked by twisting, turning, bending. #scm16

Elective treatment: 6 mm stones, multiple small stones, unable to pass after 1-2 weeks #scm16

Urgent intervention stent or nephrostomy tube. #scm16

Stat consult with fever, solitary kidney, AKI, intractable nausea and vomiting, unable to control pain. #scm16

The worldwide leader in pH test manufacturing since 1934 ...

pH tape: www.microessentiallab.com/Category/132_1/pH.20_Pap... #scm16

When you should refere to a urologist. Urgent vs elective referral. #scm16

Mathew Sorenson up next. He is a stone former and a urologist. #scm16

Average uric acid is 600 mg/day. If patient has a low urine uric acid and acidic urine, uric acid could be precipitating in jug. #scm16

urine calcium: definition of hypercalciuria: ref range 300 mg/day. Do not use wt based G/L. But it is a continuum. Lower is better #scm16

Uses 25-100 mg of chlorthalidone to lower urine calcium. Dats a lot of diuretic! I had no idea. #scm16

Curhan has patients with uric acid stones buy pH tape and check urine pH and titrates doses based on those results. #scm16

The goal is to change composition of urine so you need follow-up to confirm changes with additional 24-hour urines #scm16

In uric acid stones the most important factor is pH. XO inhibitors increase solubility by 40% increasing pH will increase it 10 fold #scm16

Thiazides not a good choice for uric acid stones. We want to give specific therapy. #scm16