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Kidney Stone Basics by Siddhivinayak Hospital Maninagar Ahmedabad
1. Basic information by ::Basic information by ::
Siddhivinayak Hospital,Siddhivinayak Hospital,
Maninagar, AhmedabadManinagar, Ahmedabad
2. IntroductionIntroduction
Conditions causing kidney stone formationConditions causing kidney stone formation
Types of kidney stonesTypes of kidney stones
Calcium saltsCalcium salts
Uric acidUric acid
Mg ammonium POMg ammonium PO44
CystineCystine
Other (xanthine, etc.)Other (xanthine, etc.)
Laboratory investigationsLaboratory investigations
3. Renal calculi (kidney stones) are formed in renalRenal calculi (kidney stones) are formed in renal
tubules, ureter or bladdertubules, ureter or bladder
Composed of metabolic products present inComposed of metabolic products present in
glomerular filtrateglomerular filtrate
These products are in high conc.These products are in high conc.
Near or above maximum solubilityNear or above maximum solubility
4. High conc. of metabolic products in glomerularHigh conc. of metabolic products in glomerular
filtratefiltrate
Changes in urine pHChanges in urine pH
Urinary stagnationUrinary stagnation
Deficiency of stone-forming inhibitors in urineDeficiency of stone-forming inhibitors in urine
5. High conc. of metabolic products in glomerular filtrateHigh conc. of metabolic products in glomerular filtrate
is due to:is due to:
Low urinary volume (with normal renal function)Low urinary volume (with normal renal function)
due to restricted fluid intakedue to restricted fluid intake
Increased fluid loss from the bodyIncreased fluid loss from the body
Increased excretion of metabolic products formingIncreased excretion of metabolic products forming
stonesstones
High plasma volume (high filtrate level)High plasma volume (high filtrate level)
Low tubular reabsorption from filtrateLow tubular reabsorption from filtrate
6. Changes in urine pH due to:Changes in urine pH due to:
Bacterial infectionBacterial infection
Precipitation of salts at different pHPrecipitation of salts at different pH
Urinary stagnation is due to:Urinary stagnation is due to:
Obstruction of urinary flowObstruction of urinary flow
7. Deficiency of stone-forming inhibitors:Deficiency of stone-forming inhibitors:
Citrate, pyrophosphate, glycoproteins inhibitCitrate, pyrophosphate, glycoproteins inhibit
growth of calcium phosphate and calciumgrowth of calcium phosphate and calcium
oxalate crystalsoxalate crystals
In type I renal tubular acidosis, hypocitraturiaIn type I renal tubular acidosis, hypocitraturia
leads to renal stonesleads to renal stones
9. 80% of kidney stones contain calcium80% of kidney stones contain calcium
The type of salt depends onThe type of salt depends on
Urine pHUrine pH
Availability of oxalateAvailability of oxalate
General appearance:General appearance:
White, hard, radioopaqueWhite, hard, radioopaque
Calcium POCalcium PO44: staghorn in renal pelvis (large): staghorn in renal pelvis (large)
Calcium oxalate: present in ureter (small)Calcium oxalate: present in ureter (small)
10. Causes of calcium salt stones:Causes of calcium salt stones:
Hypercalciuria:Hypercalciuria:
Increased urinary calcium excretionIncreased urinary calcium excretion
Men: > 7.5 mmols/dayMen: > 7.5 mmols/day
Women > 6.2 mmols/dayWomen > 6.2 mmols/day
May or may not be due to hypercalcemiaMay or may not be due to hypercalcemia
11. Hyperoxaluria:Hyperoxaluria:
Causes the formation of calcium oxalates withoutCauses the formation of calcium oxalates without
hypercalciuriahypercalciuria
Diet rich in oxalatesDiet rich in oxalates
Increased oxalate absorption in fat malabsorptionIncreased oxalate absorption in fat malabsorption
Primary hyperoxaluria:Primary hyperoxaluria:
Due to inborn errorsDue to inborn errors
Urinary oxalate excretion: > 400 mmols/dayUrinary oxalate excretion: > 400 mmols/day
13. Treatment:Treatment:
Treatment of primary causes such as infection,Treatment of primary causes such as infection,
hypercalcemia, hyperoxaluriahypercalcemia, hyperoxaluria
Oxalate-restricted dietOxalate-restricted diet
Increased fluid intakeIncreased fluid intake
Acidification of urine (by dietary changes)Acidification of urine (by dietary changes)
Calcium salt stones are formed in alkaline urineCalcium salt stones are formed in alkaline urine
14. About 8% of renal stones contain uric acidAbout 8% of renal stones contain uric acid
May be associated with hyperuricemia (with or withoutMay be associated with hyperuricemia (with or without
gout)gout)
Form in acidic urineForm in acidic urine
General appearance:General appearance:
Small, friable, yellowishSmall, friable, yellowish
May form staghornMay form staghorn
Radiolucent (plain x-rays cannot detect)Radiolucent (plain x-rays cannot detect)
Visualized by ultrasound or i.v. pyelogramVisualized by ultrasound or i.v. pyelogram
17. About 10% of all renal stones contain Mg amm.About 10% of all renal stones contain Mg amm.
POPO44
Also called struvite kidney stonesAlso called struvite kidney stones
Associated with chronic urinary tract infectionAssociated with chronic urinary tract infection
Microorganisms (such as from Proteus genus)Microorganisms (such as from Proteus genus)
that metabolize urea into ammoniathat metabolize urea into ammonia
Causing urine pH to become alkaline andCausing urine pH to become alkaline and
stone formationstone formation
18. Commonly associated with staghorn calculiCommonly associated with staghorn calculi
75% of staghorn stones are of struvite type75% of staghorn stones are of struvite type
Treatment:Treatment:
Treatment of infectionTreatment of infection
Urine acidificationUrine acidification
Increased fluid intakeIncreased fluid intake
20. A rare type of kidney stoneA rare type of kidney stone
Due to homozygous cystinuriaDue to homozygous cystinuria
Form in acidic urineForm in acidic urine
Soluble in alkaline urineSoluble in alkaline urine
Faint radio-opaqueFaint radio-opaque
Treatment:Treatment:
Increased fluid intakeIncreased fluid intake
Alkalinization of urine (by dietary changes)Alkalinization of urine (by dietary changes)
Penicillamine (binds to cysteine to form a compound morePenicillamine (binds to cysteine to form a compound more
soluble than cystine)soluble than cystine)
22. If stone has formed and removed:If stone has formed and removed:
Chemical analysis of stone helps to:Chemical analysis of stone helps to:
Identify the causeIdentify the cause
Advise patient on prevention and futureAdvise patient on prevention and future
recurrencerecurrence
23. If stone has not formed:If stone has not formed:
This type of investigation identifies causes thatThis type of investigation identifies causes that
may contribute to stone formationmay contribute to stone formation
Serum calcium and uric acid analysisSerum calcium and uric acid analysis
Urinalysis: volume, calcium, oxalates and cystineUrinalysis: volume, calcium, oxalates and cystine
levelslevels
Urine pH > 8 suggests urinary tract infection (MgUrine pH > 8 suggests urinary tract infection (Mg
amm. POamm. PO44))
Urinary tract imaging:Urinary tract imaging:
Ultrasound and i.v. pyelogramUltrasound and i.v. pyelogram