URINARY CALCULI/ UROLITHIASIS/
RENAL CALCULI
PRESENTED BY:
DAYANA SIVAN
Assistant Professor
Malik Deenar College of Nursing
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• Kidney stones, or renal calculi, or
Nephrolithiasis are solid masses made of
crystals.
• Stone formation anywhere in urinary system
are small, hard deposits that form in the urine
made up of mineral and acid salts.
• Kidney stones form in the kidneys, they can be
transported throughout the urinary tract,
which includes the kidneys, ureters, bladder,
and urethra.
Incidence
■Kidney stones are most commonly found in people
between the ages of 20-40years.
■Males .
■Sites
Pelvis
Ureters
Bladder
Risk factors
■Immobility
■Dehydration
■Reduced fluid intake
■Metabolic disturbances-hypercalcemia
■Diet rich in purine, oxalate, calcium
■Previous renal calculi
■Urinary catheterization
■Neurogenic bladder
■Acute urinary retention
■Overactive parathyroid gland
■Urinary Tract Infection
Etiology
• Urinary stasis
– Infection
– Foreign body
– Dehydration
– Obstruction in the urinary tract
– Bladder neck obstruction
– Failure to empty the bladder
– Urinary diversion
■Supersaturation of urine
– Highly concentrated minerals and salts
Inhibitor substances
– Citrate Magnesium blocks the process.
■Medications- drugs Crystallize
– Magnesium Trisilicate
– Ciprofloxacin
– Calcium carbonate, Calcium gluconate
Types of stones
■Calcium stones
■Oxalate stones/ mulberry
■Struvite stones
■Uric acid stones
■Xanthine stones
■Cystine stones
1. OXALATE STONES
■Insoluble in urine.
■Occur in persons who take large number of
cereals.
■Known as mulberry stones.
■Has sharp projections, uneven surfaces and
appears as single ones.
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2. CALCIUM STONES
■In persons with increase calcium level
■Exist as calcium phosphate, calcium
oxalate.
■Vary from small to large size
■Has stang horn appearance(like a
piece of coral or the antlers on a deer)
■Common in females of 20-30 years.
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[Link] STONES
■Are triple phosphate stones.
■Contains phosphate of
magnesium , calcium, ammonium.
■Stones will be hard.
4. URIC ACID STONES
■Seen in patients with gout.
■Those who take high purine
foods like shell fish, mushroom,
asparagus etc.
5. XANTHINE STONES
■Hereditary disorders
■Seen in children and
adolescents
6. CYSTINE STONES
• Hereditary they occur in both men and
women who have the genetic
disorder cystinuria. (Cystinuria is a condition
characterized by the buildup of the amino acid cystine,
a building block of most proteins, in the kidneys and
bladder. As the kidneys filter blood to create urine,
cystine is normally absorbed back into the
bloodstream. People with cystinuria cannot properly
reabsorb cystine into their bloodstream, so the amino
acid accumulates in their urine).
• Cystine — an acid that occurs naturally in
the body — leaks from the kidneys into the
urine.
CYSTINE STONES
Pathophysiology
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CLINICAL FEATURES
■Depends on
– size of calculi
– location
1. Pain
■Renal colic
■Radiates medially
■ downward towards bladder in females and
testis in males
■Renal colic is associated with fever, nausea
and vomiting.
URETERIC CALCULI
■Sudden quality pain
■Pain radiating to thigh and regions of
kidney
■Patient have frequent desire to void
■Patient have hematuria due to sharp
projections of stones
■High grade fever
■Anorexia
■Nausea
■ Vomiting
■Fullness in the bladder
■Decreased bladder capacity
■Intermittent micturition
■Diaphoresis(Sweating)
■Dysuria
■Urgency
■Pyuria(Pyuria is the condition of urine
containing white blood cells or pus).
■Urinary retention
Later Stages
■ Hydroureter
is a condition where the
ureter swells abnormally
due to blockage, which
can be caused by calculi
■ Hydronephrosis
describes hydrostatic
dilation of the renal
pelvis and calyces as a
result of obstruction to
urine flow downstream.
DIAGNOSTIC EVALUATION
■History collection
– Previous history or family history
– Episodes of dehydration
– Prolonged immobility
– Urinary Tract Infection
– Medications
■Physical examination
– Location, severity and radiation of pain
– Clinical features of renal calculi
■ Ultrasonography
■ Urine analysis
■ Intravenous pyelogram
■ X-ray KUB
■ CT
■ MRI
■ Blood investigations
■ Calcium, Phosphorus, Uric acid,
■ KFT/ RFT
■ Serum urea (15-45 mg/dl)
■ Serum creatinine ( 0.6-1.2 mg/dl)
MANAGEMENT
Goals:
■To identify the cause
■To relieve the symptoms
■To stop the progression of the disease
■To control infection
■To relieve obstruction
■To prevent the complications
Small stones
Drinking water.
■ 2 to 3 litres per day
■Increase fluid intake leads to forced diuresis
■Helps to flush out stones from the urinary
system
Pain relievers.
■To relieve mild pain.
■Pain relievers such as Ibuprofen, Acetaminophen or Naproxen
Sodium.
Alpha blockers
■relaxes the muscles of ureter, helping the kidney stone to move
quickly and with less pain.
■Doxazosin, Prazosin,Terazosin.
Antibiotics
■Amoxicillin
■Cefotaxime
Uric acid stones
■Allopurinol (Zyloprim, Aloprim)
to reduce uric acid levels in your blood and urine
Calcium oxalate stones
■Increase hydration.
■Reduce dietary oxalate.
■Administer thiazide diuretics.
– Thiazide diuretics.
– Increases calcium excretion
■Administer potassium citrate to maintain alkaline
urine.
SURGICAL MANAGEMENT
URETEROSCOPY
■Involves first visualizing the stone and then
destroying it.
■Access to the stone is accomplished by inserting a
ureteroscope into the ureter and then inserting a
electrohydraulic lithotripter to fragment and remove
the stones.
■A stent may be inserted and left in place for one
month to maintain the ureter patent.
LASER LITHOTRIPSY.
■A newer treatment for calculi is laser lithotripsy.
■Lasers are used together with a ureteroscope to
remove or loosen impacted stones.
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL)
• ESWL is a non-invasive procedure used to break up stones.
• In ESWL, a high-energy amplitude of pressure, or shock wave,
is generated are focussed over the area of the renal stone.
• Shock waves pass through the skin and fragment the stone.
• Repeated shock waves focused on the stone eventually reduce it
to many small pieces.
• These small pieces are excreted in the urine, usually without
difficulty.
PERCUTANEOUS
NEPHROLITHOTRIPSY
■Nephrolithotomy- incision is made over kidney to
remove the stones
■Pyelolithotomy- opening in pelvis of kidney and remove
stones
■Nephrectomy- removal of kidney
– Partial
– complete
Post operatively…..
■Monitor urine output
■Check for hematuria
■Observe for urinary retention
■Check for the stone fragments in the urine
■Check for the signs of infection
Complications
■ Obstruction
■ Infection
■ Impaired Renal function
■ Peri-renal hematoma
■ Urinary fistula formation
■ Ureteral perforation.
■ Urosepsis(the bacteria that caused the UTI can infect your
bloodstream. This condition is called urosepsis).
■ Ureteral scarring and stenosis
■ Abscess formation
THANK
YOU
