Post on 04-Oct-2020
RENAL CALCULUSMrs. Preethi Ramesh
Senior Nursing Lecturer
BGI
INTRODUCTION
Urolithiasis refers to stones (calculi) in the urinary tract &
Nephrolithiasis refers to the stones in the kidney.
Stones are formed in the urinary tract when urinary concentrations of
substances such as calcium oxalate, calcium phosphate, and uric acid
increase.
This is referred to as supersaturation and is dependent on the amount
of the substance, ionic strength, and pH of the urine.
DEFINITION
INCIDENCE
The occurrence of urinary stones occurs predominantly in the third to fifth decades of life and affects men more than women.
About half of patients with a single renal stone have another episode within 5 years.
Stone occurs more often in summer season.
Most stones contain calcium or magnesium in combination with phosphorus or oxalate.
Most stones are radiopaque and can be detected by x-ray studies.
India-each year 5-7 million cases are diagnosed.
1/1000 need hospitalization.
TYPES OF STONE
TYPES OF STONE
TYPES OF STONE
TYPES OF STONE
TYPES OF STONE
TYPES OF STONE
ETIOLOGY & RISK FACTORS
ETIOLOGY & RISK FACTORS
ETIOLOGY & RISK FACTORS
ETIOLOGY & RISK FACTORS
Chronic dehydration, poor fluid intake, and
immobility
Living in mountainous, desert, or tropical areas
Infection, urinary stasis, and periods of
immobility
Inflammatory bowel disease and in patients
with an ileostomy or bowel resection because
these patients absorb more oxalate.
Medications- antacids, acetazolamide (Diamox),
vitamin D, laxatives, and high doses of aspirin
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Many theories have been proposed to explain the formation of stones in the urinary tract. No single theory can account for stone formation in all cases.
Crystallization appears to be the primary factor in calculus development from:
1. Supersaturation of urine with increased solutes
2. Matrix formation caused when mucoproteins bind to the mass of the stone
3. Lack of inhibitors caused by increased or absent protectors against stone
formation
4. A combination of these conditions
Location of stones
Kidney
Ureter
Bladder
Urethra
RENAL CALCULUS
SITES OF OBSTRUCTION
CLINICAL MANIFESTATION
CLINICAL MANIFESTATION
1. Pain
2. Heamturia
3. Dysuria
4. Oedema
5. Pyuria
Associated symptoms:
1. Nausea, vomiting, diarrhea, abdominal discomfort
2. Chills and fever (may)
CLINICAL MANIFESTATION
1. Pain
Stones in the renal pelvis may be associated with an intense, deep ache in the costovertebral region
Pain originating in the renal area radiates anteriorly and downward toward the bladder in the female and toward the testis in the male.
If the pain suddenly becomes acute, with tenderness over the costovertebral area, and nausea and vomiting appear termed as renal colic
Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia. It is called ureteral colic
Colic is mediated by prostaglandin E, a substance that increases ureteral contractility and renal blood flow and that leads to increased intraureteral pressure and pain
If the stone present in the bladder and obstruct he urine flow, produces the pain at suprapubic region along with bladder distension
CLINICAL MANIFESTATION
2. Hematuria
Hematuria is often present because of the abrasive action of the stone.
3. Dysuria
Painful micturition is termed as dysuria.
Obstruction in urine flow tend to cause the dysuria.
4. Oedema
When the stones block the flow of urine, obstruction develops, producing an increase in hydrostatic pressure and distending the renal pelvis and proximal ureter. Thereby GFR decreases leads to sodium and water retetion and gives rise to oedema.
CLINICAL MANIFESTATION
5. Pyuria
Obstruction in urine flow, urinary retention and urinary stasis may cause the UTI and featured as pyuria.
Associated symptoms-
1. Nausea, vomiting, diarrhea, abdominal discomfort due to renointestinal reflexes and shared nerve supply (celiac ganglion) between the ureters and intestine. and the anatomic proximity of the kidneys to the stomach, pancreas, and large intestine.
2. Features of infection-
Due to UTI.
These features may be chill, high grade fever dysuria etc.
DIAGNOSTIC EVALUATION
Diagnostic evaluation
History
Physical examination
Urinanalysis
Blood studies
Stone chemistry
Radiographic studies
DIAGNOSTIC EVALUATION
History
• Diet
• Water
• Occupation
• Medication
• Past and recent medical history
• Collect the informations regarding the reasons for seeking health care
services
DIAGNOSTIC EVALUATION
Physical examination
Locate, nature and characteristics of pain
Assess the level of pain, tenderness etc.
Observe for the associated symptoms.
DIAGNOSTIC EVALUATION
Urinanalysis
• Hematuria and pyuria
• pH < 5.5 indicates uric acid stone
• pH > 7.5 indicates struvite stone
• Urine culture and drug sensitivity studies to
detect infection.
• 24-hour urine test for measurement of calcium,
uric acid, creatinine, sodium,citrate and oxalate
DIAGNOSTIC EVALUATION
Blood studies
• Hyperuracemia
• Hypercalcemia
• Neutrophilia
• Elevated serum parathyroid hormone
DIAGNOSTIC EVALUATION
Stone chemistry
• Collection of stone through a strainer is useful.
• Analyze the stone chemically to find out the composition which helps in
therapeutic management.
DIAGNOSTIC EVALUATION
Radiographic studies
• Kidney, ureters, and bladder
radiography may show stone.
• Intra venous urogram (intravenous
pyelogram) to determine site and
evaluate degree of obstruction
• Retrograde pyelography
• Ultrasound
• Helical or axial CAT Scan
CONTINUES…
STAY BLESSED