RENAL CALCULUS

1. 1 KIDNEY STONE 
2. 2. OBJECTIVES • INTRODUCTION • INCIDENCE • STONE FORMATION • TYPES OF STONES • CLINICAL MANIFESTATIONS • CAUSES & RISK FACTORS • PATHOPHYSIOLOGY • TREATMENT & PREVENTION
3. 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. 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. 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. 6. TYPES OF KIDNEY STONES  Calcium oxalate  Calcium phosphate  Struvite  Uric acid  Cystine
7. 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. 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. 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. 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. 11. RISK FACTORS HIGH MINERAL CONTENT IN DRINKING WATER DEHYDRATION FAMILY OR PERSONAL HISTORY DIETARY INTAKE BEING OBESE
12. 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. 13. DIAGNOSTIC STUDIES RETROGRADE PYELOGRAM DRUG THERAPY- Opioids,NSAIDs. 24 HOUR URINE SPECIMEN LAB INVESTIGATION S
14. 14. TREATMENT & PREVENTION Acute Treatment:  Pain Medication!!  Strain urine for stones  Keep Hydrated  Ambulation  Diet Restrictions  Emotional Support  Invasive Procedure (may be necessary)
15. 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. 16. Lithotripsy Basket Extraction
17. 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. 18. EAT WELL, STAY WELL….
19. 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