Renal calculi•Nephrolithiasis refers to renal stone disease; urolithiasis refers to the presence...

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Renal calculi

Presented by:- Bhagawati ray

DEFINITION• Nephrolithiasis refers to renal stone

disease; urolithiasis refers to the presence of stones in the urinary system. Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine

ETIOLOGYMETABOLIC

LIFESTYLE

GENETIC FACTORS

DRUGS

OTHERS

RISK FACTORS

METABOLIC

HISTORY OFRENAL

DISTURBANCES CALCULI DEHYDRATION

SEDENTARY LIFE STYLE

IMMOBILITY

RISK FACTORSHIGH MINERAL CONTENT IN DRINKING WATER

DIETARY INTAKE

UTI & H/O FEMALE GENITALMUTILATION

PROLONGED INDWELLING CATHETERISATION

NEUROGENIC BLADDER

PATHOPHYSIOLOGY

• Slow urine flow, resulting in

supersaturation of the urine

with the particular element

that first become crystallized

and later become stone

PATHOPHYSIOLOGY

• Damage to the lining of the

urinary tract

PATHOPHYSIOLOGY

• Decreased inhibitor

substances in the urine that

would otherwise prevent

supersaturation and

crystalline aggregation

TYPES OF STONES• Calcium Phosphate

• Calcium oxalate

• Uric acid

• Cystine

• Struvite

CLINICAL MANIFESTSTIONS• Severe

abdominal or flank pain

• Frequency and dysuria

• Oliguria and anuria in obstruction

CLINICAL MANIFESTSTIONS

• Hematuria

• Renal colic

• Nausea

• hydronephrosis

DIAGNOSTIC STUDIES

DIAGNOSTIC STUDIES

DIAGNOSTIC STUDIESC

YSTO

SCO

PY

DIAGNOSTIC STUDIES

DIAGNOSTIC STUDIES

DIAGNOSTIC STUDIES

RETROGRADE

PYELOGRAM

CT SCAN

24 HOUR URINE

SPECIMEN

LAB INVESTIGATIONS

MANAGEMENT

MEDICAL

• DRUG THERAPY- Opioid

agents NSAIDS

Spasmolytic agents

COMPLIMENTARY THERAPY

• Hypnosis, imagery, therapeutic or healing touch, acupuncture and breathing techniques

• Positioning the client to comfortable position aids in pain reduction

OTHER TECHNIQUES• Avoiding over

hydration and under hydration

• Strain the urine

• Send any strained stone to laboratory to aid in preventive treatment in the future

SPECIFIC APPROACHESURINARY

STONE

CHARACTERIS

TICS

PREDISPOSING

FACTORS

THERAPEUTIC MEASURES

Calcium

oxalate

35-40

Small

often

possible to

get

trapped in

ureter

,more

frequent in

men

Idiopathic

hypercalciuria

hyperoxaluria

,Independent

of urinary pH

,family history

Increase hydration

Reduce dietary oxalate

Give thiazide diuretics

cellulose phosphate,(chelate

calcium and prevent GI

absorption),

potassium citrate(alkaline

urine),

cholestyramine(bind

oxalate),

calcium lactate(precipitate

oxalate in GI tract)

Reduce daily sodium intake

SPECIFIC APPROACHESURINARY

STONE

CHARACT

ERISTICS

PREDISPOSING

FACTORS

THERAPEUTIC MEASURES

Calcium Mixed Alkaline urine, Treat underlying

phosphate stones primary cause and other

8-10% with hyperthyroidism stones

struvite

or

oxalate

stones

SPECIFIC APPROACHESURINARY

STONE

CHARACTERIS

TICS

PREDISPOSING

FACTORS

THERAPEUTIC MEASURES

Struvite 3 to 4 times urinary tract Antimicrobial agents

10-15 % common in infections acetohydroxamicacid

women ≥ Surgical interventions

men,always Measures to acidify urine

in

association

with urinary

tract

infection

SPECIFIC APPROACHES

URINARY

STONE

CHARACTERI

STICS

PREDISPOSING

FACTORS

THERAPEUTIC MEASURES

Uric

acid

5-8 %

Predomi

nant in

men high

incidence

in jewish

men

Gout, acid

urine

,inherited

conditions

Reduce urinary

concentration of uric acid

Alkanize urine with

potassium citrate

Administer allopurinol

Reduce dietary purines

SPECIFIC APPROACHES

URINARY

STONE

CHARACTERISTICS PREDISPOSING

FACTORS

THERAPEUTIC MEASURES

Cystine

1-2 %

Genetic

autosomal

recessive

defect,defective

absorption of gi

cystine from gi

tract and kidney

excess

concentrations

causing stone

formation

Acid urine Increase hydration

Give α pencillamine and

tiopronin to prevent cystine

crystallization

Potassium citrate to

alkaline urine

SURGICAL MANAGEMENT

PROXIMAL URETER

ESWL

RETROGRADE

ANTEGRADENEPHROURETER

OLITHOTOMY

URETEROSCOPY

STENTING ALONE

PERCUTANEOUS URETERO

LITHOTOMY

NEPHROLITHOTOMY

MID URETER

RETROGRADE URETEROSCOPY

ESWL

ANTEGRADE NEPHROSTOURETE

ROLITHOTOMY

OPEN URETERO-LITHOTOMY

DISTAL URETER

ESWL/ureteroscopy

Antegrade nephrostoureterolithotomy

Stenting alone

Open ureterolithotomy

SURGICAL MANAGEMENT

LASER

PERCUTANEOUS

ESWL

OPEN SURGICAL PROCEDURES

NEPHROLITHO TOMY

PYELOLITHOT OMY

URETHROLIT HOTOMY

CYSTOTOMY

PREVENTION

PREVENTION

• Avoid protein intake; usually protein is

restricted to 60g/day to decrease urinary

excretion of calcium and uric acid.

• A sodium intake of 3 to 4 g/day is

recommended.Table salt and high-sodium

foods should be reduced, because sodium

competes with calcium for reabsorption

in the kidneys.

• Low-calcium diets are not generally

recommended,except for true absorptive

hypercalciuria. Evidence shows that limiting

calcium, especially in women, can lead to

osteoporosis and does not prevent renal

stones.

• Avoid intake of oxalate-containing foods

(eg,spinach,strawberries,rhubarb,tea,peanuts,

wheat bran).

PREVENTION

• During the day, drink fluids (ideallywater)

every1 to 2 hours.

• Drink two glasses of water at bedtime

and an additional glass at each nighttime

awakening to prevent urine from

becoming too concentrated during the

night.

PREVENTION

• Avoid activities leading to sudden

increases in environmental temperatures

that may cause excessive sweating and

dehydration.

• Contact your primary health care

provider at the first sign of a urinary

tract infection

PREVENTION

QUESTIONS

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Thank you!!!