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Calculi Formation
- 1. CALCULI FORMATION Bonifacio |Bueno | Burton | Busa | Cariaga FEU NRMF Medicine 1-C
- 2. CALCULI • An abnormalor pathologic concretion or mass of mineral salts that occur in the body • Precipitation or crystallization of minerals in organs such as the kidneys or the gall bladder CALCULI
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- 6. CALCULI GALLSTONES • Cholesterol stones •Most common • Form when amount of cholesterol exceeds or supersaturates capacity of bile • Pigment stones • From crystallization of calcium bilirubinate • May indicate infection • Black or brown TYPES OF CALCULI
- 7. CALCULI RENAL STONES • Calciumstones • Most common renal stones • Contain Ca, PO4, oxalate • Caused by excessive Ca in the body • Hyperparathyroidism TYPES OF CALCULI
- 8. CALCULI • Uric acid •Formed due to • Low urine output • High protein diet • Increased alcohol intake • Struvite • Affect more women than men • May accompany renal infections TYPES OF CALCULI RENAL STONES
- 9. CALCULI RENAL STONES • Cystine •Rare • Typically occur in individuals with family history of cystinuria TYPES OF CALCULI
- 10. CALCULI GALLSTONES: Cholesterol • Supersaturationof bile with cholesterol • Intestinal hypomotility • Excess in pro-nucleation factors, deficiency of anti-nucleation factors • Hypersecretion of mucus in the gall bladder PROMOTING FACTORS
- 11. CALCULI GALLSTONES: Pigment • Elevatedlevels of unconjugated bilirubin in the blood • Hemolytic diseases • Severe ileal dysfunction • Intestinal hypomotility • Infection of the biliary tree • Bacteria (E. coli) • Parasite (Ascaris lumbricoides) • Fungi (Ophiocordyceps sinensi) PROMOTING FACTORS
- 12. CALCULI RENAL STONES • Slowurine flow • Damaged urinary tract lining • Absence of inhibitory proteins (nephrocalcin, Tamm-Horsfall protein, uropontin) • Intake of medication • Dehydration PROMOTING FACTORS
- 13. CALCULI RENAL STONES • UrinepH • Acidic pH: favour precipitation and formation of uric acid stones and cystine stones • Alkaline pH: CaPO4 stones and struvite stones PROMOTING FACTORS
- 14. CALCULI RENAL STONES • Sufficientconsumption of water • Decreased protein intake • Reduced sodium consumption • Frequent drinking of water PREVENTIVE FACTORS
- 15. CALCULI RENAL STONES • Normalconcentration of urine elements • Normal urine parameters (volume, pH, etc) • Presence of inhibitory proteins (Tamm- Horsfall protein, nephrocalcin, uropontin) • Prevention of urine stasis (timely and sufficient voiding) PREVENTIVE FACTORS
- 16. CALCULI GALLSTONES • Normal compositionof gall bladder contents • Low-fat, low-cholesterol diet • High fiber intake • Decreased sugar consumption • Physical exertion/exercise PREVENTIVE FACTORS
- 17. CALCULI CHOLELITHIASIS UROLITHIASIS Increasing ageMiddle aged (35-45) Female gender Male gender Gall bladder stasis Urinary stasis Pregnancy Geography Diet, obesity, physical inactivity Diet, obesity Ethnicity Nationality Cirrhosis History of cystinuria Family history Family history of nephrolithiasis Ileal disease, ileal resection Chronic UTI Medications Dehydration Rapid weight loss RISK FACTORS
- 18. CALCULI •CLDN-14 •Polymorphisms occuring at: •Calcium-sensing receptor (CSR) • Vitamin D receptor (VDR) • Osteopontin (OPN) GENETIC BASIS OF PREDISPOSITION
- 19. CALCULI GALLSTONES • Pulsating, propagatingpain that disappears shortly after it begins • Pain in the upper right portion of the abdomen • Pain immediately below the area of the breast • Pain in the right shoulder • Referred pain CLINICAL MANIFESTATIONS
- 20. CALCULI RENAL STONES • Severepain in the back and sides of the abdomen, just below the ribs • May spread to groin area • In the case of an infection, symptoms include nausea or vomiting, fever, and chills CLINICAL MANIFESTATIONS
- 21. CALCULI RENAL STONES CLINICAL MANIFESTATIONS • Painfulurination • Hematuria or pink, red, or brown urine with a foul odour • Changes in the voiding pattern • Small amounts of urine may be voided at a time.
- 22. CALCULI RENAL STONES • Severerenal obstruction and the possibility of infection • Kidney failure GALLSTONES • Gall bladder inflammation • Common bile/pancreatic duct blockage • Gall bladder cancer COMPLICATIONS
- 23. CALCULI RENAL STONES • Urineexamination • Hematuria • Pyuria • BUN, creatinine, and electrolytes • Abdominal ultrasound • Intravenous pyelogram (IVP) LAB DIAGNOSIS
- 24. CALCULI GALLSTONES • Elevated serumaminotransferase, alkaline phosphatase, bilirubin and amylase • Blood test: look for signs of infection, obstruction, pancreatitis, or jaundice. • Oral cholecystogram • Bile microscopy • Cholescintigraphy • Physical examination (Murphy’s technique) • MRI, CT scan, ultrasound LAB DIAGNOSIS
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- 26. CALCULI GALLSTONES •Administration of Ursodiol •Contactdistribution therapy • Use organic solvent methyl tert-butyl ether (MTBE) •Surgical removal TREATMENT
- 27. CALCULI RENAL STONES • Extracorporalshockwave lithotripsy (ESWL) • Percutaneous nephrolithotomy • Ureteroscopy • Open surgery • Medication TREATMENT
- 28. CALCULI RENAL STONES TREATMENT Etiology InterventionDosage/Recommendation URIC ACID Normal 24-h uric acid levels, but urine pH <5.5 Alkali-citrate preparations (preferred) Potassium citrate:40-60 mEq of citrate in 24 h (divided doses) Sodium-based preparations Sodium bicarbonate: 1, 300 mg bid CYSTINE Genetic: Autosomal Recessive Restrict dietary methionine (sulfur) intake Limit meat, eggs dairy products, legumes, grains Alkali-citrate preparations Potassium citrate: 40-60 mEq of citrate in 24h (divided doses)
- 29. CALCULI RENAL STONES TREATMENT Etiology InterventionDosage/Recommendation CYSTINE Genetic: Autosomal Recessive Sodium-based preparations Sodium bicarbonate: 1, 300mg bid Thiol-binders α-mercaptopropionylglycine (tiopronin): 200-300md tid (up to 1, 000mg in 24h) D-penicillamine: 250mg qd; gradually titrate to 2, 000mg in 24h Captopril: 50mg tid (not preferred)
- 30. CALCULI RENAL STONES TREATMENT STRUVITE Urine pH>7; Chronic infection of genitourinary tract with urease-producing bacteria (Proteus, Pseudomonas, or Kiebsiella spp) or yeast Surgical treatment (preferred) Ureteroscopy, percutaneous nephrolithotomy Urease inhibitors AHA; 250 mg tid-qid (up to 1, 500mg in24 h) Hydroxyurea: 500mg qd Antibitotics (short duration) Ciprofloxacin: 250-500mg bid Levofloxacin: 250-750mg qd Ofloxacin: 200mg bid Urine acidifiers Ammonium chloride: 1, 000mg bid-tid Methionine: 200-500mg qd- tid Betaine: 650mg tid with a meal Cranberry juice: > 16 oz in 24h
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