RENAL CALCULUS AETIOLOGY Males- radio-opaque gall stones Females - Radiolucent gall stones Diet:Vitamin A deficiency it causes desquamation of epithelium which acts as a nidus for stone formation. Climate: In hot climate urinary solutes will increase with decrease in colloids,

1. en love da Homoeopathy
RENAL
CALCULUS

2. RENAL
CALCULUS

3. RENALCALCULUS
AETIOLOGY
• Males- radio-opaque gall
stones
• Females - Radiolucent gall
stones
• Diet:Vitamin A deficiency
• it causes desquamation
of epithelium
• whichacts as a nidus for
stone formation.
• Climate:
• In hot climateurinary
solutes will increase with
decreasein colloids,

4. • whichleads to chelation of
solutewith calciumforming
a nidus for stone.
• Citratelevel in urine (300–
900 mg/24hours)
• maintains the calcium
phosphateand
carbonate in soluble
state
• and any decrease in
citratelevel in urine
causes stone formation.
• Infectionin kidney
• Urea splitting
organisms commonly
cause stone formation
• i.e. E. coli,
Staphylococcus,
Streptococcus, Proteus.
• Prolongedimmobilisation
causes decalcificationof
bones and so
hypercalciuria leading to
stoneformation.

5. • Hyperparathyroidism
causes hypercalciuria
causing multiplebilateral
stones or often bilateral
nephrocalcinosis (5%).
• Hyperoxaluria, as a result
of alteredglycine
metabolism.
• Cystinuria (Autosomal
recessive).
• Stasis due to obstructionto
urine flow.
• Medullary spongekidney.
• Randall’s plaque theory is
erosion and deposition of
urinary salts as Randall’s
plaque at the apexof renal
papillae.
• Carr’s postulates states
that minute concretions
called as microliths
↓
normally develop in the
subendothelial part of the
tubule

6. ↓
whichwill be carriedaway as
particles by renal lymphatic
network vessels.
↓
If these lymphatics are blocked,
microliths enlarge
↓
and act as nidus for stone
formation.
• Others:
• Sarcoidosis
• Myelomatosis
• Gout
• idiopathic
hypercalciuria
• hypervitaminosis D
• neoplasms on
treatment,
hypomagnesuria
(Mg++ in urine acts as
a complexing agent
and prevents
nucleationnormally).

7. TYPES
Stages of stone formation
• I. Supersaturation
• II. Nucleus formation
• III. Crystallisation
• IV. Aggregation
• V. Matrix formation
• VI. Stone
1. Oxalate stones
• Also called as mulberry
stone as it is brownin
colour, withsharp
projections.
• It is invariably calcium
oxalate stone, shows
envelope crystals in urine.

8. 2. Phosphatestones
• It is either calcium
phosphateor calcium,
magnesium, ammonium
phosphatestone
• usually occurring in an
infected urine.
• It is smoothand white in
colour.
• In an alkaline urine, it
enlarges rapidly, filling renal
calyces taking their shape
called as staghorncalculus.
• It is radio-opaque and
attains a large size.
3. Uric acid stones
• are smooth, hard, yellowish,
multiple and radiolucent.
• They are seenin gout, hyper
uricosuria, altered purine
metabolism.
4. Uratestones
5. Cystine stones
• occur in cystinuria where
there is defective absorption
of cystine fromthe renal
tubules (autosomal recessive
condition).

9. • It is seen in young girls,
occurs only in acidicurine. It
is multiple, soft, yellowin
colour greenish hue on
exposure.
• It attains large size.
• It is radioopaque becauseit
contains sulphur
6. Xanthine stones
• are very rare, smooth, brick
red in colour, due to altered
xanthine metabolism.
• Here there is deficiencyin
xanthine oxidase enzyme.
7. Indigostones
• Veryrare.
• Blue in colour
8. Struvite stone:
• It is compound of
magnesium, ammonium
phosphate mixedwith
carbonate.
• It occurs in presence of
ammoniaand urea
splitting organisms in
urine
• e.g. Proteus;Klebsiella.

10. SHAPEOF STONE
• a. Calciumoxalate
monohydrateDumbell
shaped
• b. Calciumoxalate dihydrate
Envelope shaped
• c. Uric acidYellowish of
varying size and shape
• d. Cystine Hexagonal, very
soft stones
• e. Triple stone Coffin lid
shaped
CLINICALFEATURES
• Pain—renal painis located
over renal angle,
hypochondriumand lumbar
region.
• Oftensevere radiating to
groin and testis in male,
with vomiting due to
pylorospasm. Painworsens
on movements.
• Haematuriais common
• Pyuria.
• Fever.

11. • Tenderness in renal angle,
with often a mass in the loin
due to hydronephrosis
whichmoves with
respirationand is
bimanually palpable,
ballotable, smooth, soft.
• As urinary tractinfection.
• Incidental finding.
• Oftenhypertension
INVESTIGATION
• Blood: ESR, serumcalcium,
phosphate, creatinine, blood
urea, uricacid, PTHlevel.
• Urine: Calcium, urate,
cystine if suspectedonly,
pH, specificgravity.
• PlainX-ray, KUB: To see
kidney shadow, stones
(90%—radio-opaque).
• IVUto see renal functions
and HN.

12. • RGP if required.
• Ultrasoundabdomen—can
detectevenradiolucent
stones and gives information
about the changes in renal
parenchyma.
• Urine analysis and C/S to
identify bacteria.
• CT scanwill identify the
small missed stones in
ureter.
TREATMENT
1. PCNL(Percutaneous
Nephrolithotomy).
Indications
• Stones more than 2.5 cm in
size
• Multiple stones
• Stones not responding for
ESWL
2. ESWL(Extracorporeal Shock
Wave Lithotripsy):
• Piezo-Ceramicor
Electromagneticshock waves
are passedto the stone
through water bath

13. • or water cushionwhichacts
as a media
• Dornier Lithotripter is used
for fragmenting stones
• Stone is located and
observedthrough
fluoroscope (C-arm) or
ultrasound.
• Shockwaves are triggered to
createcompressive waves
over the stone, to fragment
it.
• Thesefragments are flushed
out later.
ADVANTAGES
• No anaesthesia is required
• Canbe done as an OP
procedure
• Less than2.5 cm sizedstones
are well fragmented
• Hard stones, oxalate stones
are better eliminatedby
ESWL
• ESWLcanbe done
repeatedly in different
sittings
• If it is not successful one can
switchover to PCNL

14. COMPLICATIONS
• Renal haematoma
• Severe haematuria
• Injury to adjacent structures
• Fragmented stone retains in
theureter
CONTRAINDICATIONS
• Pregnancy
• Bleeding disorders
• Patients with abdominal
aneurysms
• Sepsis and renal failure
(Serumcreatinine more than
3 mg)
TREATMENT
• Flushtherapy—mainly
used for lower ureteric
stones.
• IV fluids.
• Injfrusemide60–80 mg
• Anti-inflammatory and
antispasmodic agents are
givento relieve the pain.

15. SURGERY FOR RENAL
STONES
• Presentlymost of the renal
stones can be removed
without opensurgery
(PCNL, ESWL, URS).
• But limiting factors are
cost and availability.
• Pyelolithotomy. Suitable
for stones in extrarenal
pelvis
• Extendedpyelolithotomy
(Gil-Vernet)
• Nephrolithotomy
• Nephropyelolithotomy
• Partial nephrectomy
• Benchsurgery: Kidney is
removed out temporarily
• Coagulumpyelolithotomy
• Anatrophicpyelolithotomy

16. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

17. A
Special Thanks
To A Very
Special Doctor