- 1 KIDNEY STONE
- 2. OBJECTIVES • INTRODUCTION • INCIDENCE • STONE FORMATION • TYPES OF STONES • CLINICAL MANIFESTATIONS • CAUSES & RISK FACTORS • PATHOPHYSIOLOGY • TREATMENT & PREVENTION
- 3. INTRODUCTION Kidney Stones, also known as renal calculus or nephrolith, are small, hard deposits of mineral and acid salts on the inner surfaces of the kidneys. If stones grow to sufficient size they can cause blockage of the ureter. kidney-------- stone (calcium) gall bladder---- stone (cholesterol oxalates) intestine ------- jejunum (hard substance)
- 4. INCIDENCE Urinary calculi are more common in men than in women. Incidence of urinary calculi peaks between the 3rd and 5th decades of life. 80% of stones under 2mm in size 90% of stones pass through the urinary system spontaneously There is seasonal variation with stone occurring more often in the summer months suspecting the role of dehydration in this process.
- 5. STONE FORMATION Highly concentrated urine constituents crystallize and harden to form calculi. Kidney stones form when our urine contains more crystal- forming substances — such as calcium, oxalate and uric acid. At the same time, our urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form. The crystals get deposited on the nucleus and continue to grow. These can some times adhere to the renal papillae.
- 6. TYPES OF KIDNEY STONES Calcium oxalate Calcium phosphate Struvite Uric acid Cystine
- 7. Calcium stones: Most kidney stones are calcium stones, usually in the form of calcium oxalate and calcium phosphate. Oxalate is a naturally occurring substance found in food. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels. Our liver also produces oxalate. IN ALKALINE URINE ENLARGES RAPIDLY TAKE SHAPE OF CALYCES STAGHORN CALCIUM PHOSPHATE
- 8. Uric Acid: This type of kidney stone is more common in men than in women. They can occur in people with gout or those going through chemotherapy. Struvite: This type of stone is found mostly in women with urinary tract infection. These stones can be quite large and cause urinary obstruction. Cystine: Cystine stones are rare. They occur in both men and women who have the genetic disorder cystinuria. Other: Other, rarer types of kidney stones also can occur. Such as XANTHINE STONES, DIHYDROXY ADENINE STONE, SILICATE STONES etc.
- 9. CLINICAL MANIFESTATIONS Severe flank pain Abdominal pain Nausea and vomiting Fatigue Elevated temperature, BP, and respirations Steady Pain Pain on urination; Pink, red or brown urine Oliguria and anuria in obstruction Hematuria Renal colic Hydronephrosis
- 10. CAUSES Supersaturation of urine is the key to stone formation Imbalance of pH in urine Gout Hyperparathyroidism Inflammatory Bowel Disease UTI (Urinary Tract Infections) Dehydration Crystal aggregation
- 11. RISK FACTORS HIGH MINERAL CONTENT IN DRINKING WATER DEHYDRATION FAMILY OR PERSONAL HISTORY DIETARY INTAKE BEING OBESE
- 12. PATHOPHYSIOLOGY • Slow urine flow, resulting in super saturation of the urine. • Damage to the lining of the urinary tract • Decreased inhibitor substances in the urine that would otherwise prevent super saturation and crystalline aggregation.
- 13. DIAGNOSTIC STUDIES RETROGRADE PYELOGRAM DRUG THERAPY- Opioids,NSAIDs. 24 HOUR URINE SPECIMEN LAB INVESTIGATION S
- 14. TREATMENT & PREVENTION Acute Treatment: Pain Medication!! Strain urine for stones Keep Hydrated Ambulation Diet Restrictions Emotional Support Invasive Procedure (may be necessary)
- 15. Surgical Procedures Lithotripsy: used sound wave to break up large stones into smaller fragments allowing it to pass through the urinary tract. Extracorporeal Shock-Wave Lithotrypsy (ESWL) Percutaneous Ultrasonic Electrohydraulic Laser Surgical Therapy Nephrolithotomy (Kidney) Pyelolithotomy (Renal Pelvis) Ureterolithotomy (Ureter) Basket Extraction/Ureteroscopy
- 16. Lithotripsy Basket Extraction
- 17. PREVENTION Hydration Drink 3 liters of fluid per day (14 cups) Ideally water Lemonade (citrate decrease stone formation) Diet Low sodium & calcium intake. Avoid intake of oxalate-containing foods (eg, spinach,strawberries, rhubarb, tea, peanuts, wheat bran). Low protein intake is required. Exercise/Increase Activity -Avoid activities leading to sudden increases in environmental temperatures that may cause excessive sweating and dehydration.
- 18. EAT WELL, STAY WELL….
- 19. MEDICATIONS Pain relief may require narcotic medications. The presence of infection requires treatment with antibiotics. Other medications include: allopurinol for uric acid stones diuretics sodium bicarbonate or sodium citrate phosphorus solutions
Thursday, 28 February 2019
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