There are four main types of kidney stones: calcium, uric acid, struvite, and cystine. Calcium stones are the most common, forming when there are high levels of calcium or oxalate in the urine. Uric acid stones form when urine is acidic. Struvite stones often form due to urinary tract infections, and can grow quite large. Cystine stones occur in people with a rare genetic disorder. Kidney stones are diagnosed through physical exams, blood and urine tests, and imaging tests like ultrasound or CT scans. Treatment involves increasing fluid intake, using medication to prevent stone formation, or surgical procedures like ESWL to break up stones.

1. KİDNEY STONE
DR.MEHMET UMUT ÖZBAY
DR.KÜRŞAD AKÇAKALE

2. A kidney stone is a hard mass developed from crystals that
separate from the urine and build up on the inner surfaces of the
kidney.
What are kidney stones?
Kidney stones are made of salts and minerals in
the urine that stick together, creating small
"pebbles" formed within the kidney or urinary
tract. They can be as small as grains of sand or as
large as golf balls. Kidney stones are a common
cause of blood in the urine and often severe pain
in the abdomen, flank, or groin. One in every 20
people develops a kidney stone at some point in
their life.

5. WHAT ARE THE TYPES OF KİDNEY STONES?
• THERE ARE FOUR MAİN TYPES OF KİDNEY
STONES.
• CALCİUM STONES
• URİC ACİD STONES
• STRUVİTE STONES
• CYSTİNE STONES

6. CALCİUM STONES ?
• Most kidney stones are made
of calcium compounds, especially calciumoxalate.
• Calcium phosphate and other minerals also may be
present.
• Oxalate is a naturally occurring substance found in
food(Some fruits and vegetables, as well as nuts and
chocolate, have high oxalate levels).
• Your liver also produces oxalate.
• Dietary factors, high doses of vitamin D, intestinal
bypass surgery and several metabolic disorders can
increase the concentration of calcium or oxalate in
urine.

7. • Conditions that cause high calcium levels in the body,
such as hyperparathyroidism, increase the risk of
calcium stones.
• Certain medicines may prevent calcium stones.
• Population: 80 %
• Circumstances:when urine is alkaline (ph>5.5)

8. URİC ACİD STONES ?
• Some kidney stones are made of uric acid, a waste
product normally passed out of the body in the urine
• You are more likely to have uric acid stones if you
have: -Low urine output.
-A diet high in animal
protein, such as red meat.
-An increase in how much
alcohol you drink.
-Gout.
- Inflammatory bowel disease

9. • Uric acid stones can form in people who don't drink
enough fluids or who lose too much fluid, those who
eat a high-protein diet, and those who have gout.
• Certain medicines may prevent or dissolve uric acid
stones.
• Population: 5–10%
• Circumstances: when urine is persistently acidic

10. STRUVİTE STONES ?
• Some kidney stones are struvite stones.
• They can also be called infection stones if they occur
with kidney or urinary tract infections (UTIs).
• These types of kidney stones sometimes are also
called staghorn calculi if they grow large enough.
• Struvite stones can be serious, because they are
often large stones and may occur with an infection.
• Medical treatment, including antibiotics and removal
of the stone, is usually needed for struvite stones.
• Women are affected more than men because of their
higher risk of urinary tract infections

11. • These stones can grow quickly and become
quite large, sometimes with few symptoms or
little warning.
• Population: 10–15%
• Circumstances: infections in the kidney

12. CYSTİNE STONES ?
• Less common are kidney stones made of a chemical
called cystine.
• These stones form in people with a hereditary
disorder that causes the kidneys to excrete too much
of certain amino acids (cystinuria).
• Cystine stones may be prevented or dissolved with
medicine. But this may be difficult and not very
effective.
• If a stone causes blockage in the urinary tract or is
too large, then it will need to be removed.

13. • Population: 1–2%
• Circumstances: rare genetic disorder

15. The most common cause of kidney stones is not
drinking enough water.
What causes kidney stones?
• Kidney stones form when a change occurs in the
normal balance of water, salts, minerals, and other
substances found in urine
• Other chemical compounds that can form stones in
the urinary tract include uric acid and the amino acid
cystine.
• Dehydration through reduced fluid intake and
strenuous exercise without adequate fluid
replacement increase the risk of kidney stones.

16. • Some people are more likely to get kidney stones because
of a medical condition or family history, as the tendency to
form kidney stones may also be inherited.
• If other people in your family have had them, you may have
them too

17. Symptoms and signs of a kidney stone include excruciating,
cramping pain in the lower back and/or side, groin, or
abdomen as well as blood in the urine.
• What are symptoms of kidney stones?
• Kidney stones often cause no pain while they are in
the kidneys, but they can cause sudden, severe pain
as they travel from the kidneys to the bladder
• Symptoms and signs include excruciating, cramping
pain in the lower back and/or side, groin, or
abdomen as well as blood in the urine
• . If infection is present in the urinary tract along with
the stones, there may be fever and chills.
• Also occur: Pain on urination, pink, red or brown
urine, Cloudy or foul-smelling urine

19. How are kidney stones diagnosed?
• THERE ARE FOUR MAİN TYPES OF KİDNEY
STONES DİAGNOSED
1-)PHYSİCAL EXAMİNATİON
2-) BLOOD TEST
3-) URİNE TEST
4-) İMANGİNG TEST

20. 2-)BLOOD TEST
• Uric acid
• Calcium
• Phosphate
• Creatine
• 3-)URİNE TEST
• To determine whether bleeding in the urine
• Sodium
• Calcium
• Phosphate
• Erythrocyte

21. 4-)İMANGİNG TEST
• X-RAY(we cant see all stones in x-ray)
• ULTRASOUND(its good methods to diognes stone, we can
see stone region , stone size and kidney size but we cant
see urethra stones in ultrasound.Also its good methods for
pregran women)
• CT(we can see all stones in ct)

23. KİDNEY STONES TREATMENT ?
• Drink enough fluids
• Drugs(pain drugs:nonsteroidal anti inflammotary,
acetaminophen , naproxen sodium.For calcium
stone:Orthophosphat, Potassium citrate, Thiazides ,
for uric acid stone: Allopurinol, Potassium citrate,
Sodium bicarbonate , for cystine stone:Penicillamine,
Potassium citrate, Tiopronin and for strutive
stone:need surgery to remove stone
• Surgery(Remove kidney stone this include :
extracorporeal shock wave lithotripsy (ESWL),
ureteroscopy, percutaneous nephrolithotomy (PCNL),
open surgery

24. Extracorporeal shock wave lithotripsy (ESWL)
• ESWL is the most common way of treating kidney stones that
cannot be passed in the urine.
• It involves using X-rays (high-energy radiation) or ultrasound
(high-frequency sound waves) to pinpoint where a kidney
stone is
• A machine then sends shock waves of energy to the stone to
break it into smaller pieces so it can be passed in your urine.
• ESWL can be an uncomfortable form of treatment, so it is
usually performed after giving painkilling medication.
• You may need more than one session of ESWL to treat your
kidney stones successfully.
• ESWL is up to 99% effective for stones that are up to 20mm
(0.8in) in diameter.

26. Ureterorenoscopy
• If a kidney stone is stuck in your ureter (tube that carries waste products
from your kidneys to your bladder), you may need to have
ureterorenoscopy.
• Ureterorenoscopy is also sometimes known as retrograde intrarenal
surgery (RIRS)
• It involves passing a long, thin telescope called a ureteroscope through
your urethra (the tube urine passes through out of the body) and into your
bladder.
• It is then passed up into your ureter to where the stone is stuck.
• The surgeon may either try to gently remove the stone using another
instrument, or they may use laser energy to break the stone up into small
pieces so that it can be passed naturally in your urine.
• Ureterorenoscopy is performed under general anaesthetic, so you should
not drive or operate machinery for up to 48 hours after the procedure
• For stones up to 15mm (0.6in), an ureterorenoscopy is effective in 50-80%
of cases.
• You may need a plastic tube called a stent to be inserted inside you
temporarily to allow the stone fragments to drain into the bladder.

28. Percutaneous nephrolithotomy (PCNL)
• PCNL is an alternative procedure that may be used for larger
stones.
• It may also be used if ESWL is not suitable (for example,
because the person being treated is obese).
• PCNL involves using a thin telescopic instrument called a
nephroscope.
• An incision (cut) is made in your back. The nephroscope is
passed through the incision and into your kidney
• The stone is either pulled out or broken into smaller pieces
using a laser or pneumatic energy.
• It is always performed under general anaesthetic (you are put
to sleep), which means that you should not drive or operate
machinery for up to 48 hours after the procedure.
• PCNL is 86% effective for stones that are 21-30mm (0.8-1.2in)
in diameter.

30. Open surgery
• If you have a uric acid stone, you may be
advised to drink around three litres of water
each day to try to dissolve it.
• Uric acid stones are much softer than other
types of kidney stone, and they can be made
smaller if they are exposed to alkaline fluids.
• You may need to take some medication to
make your urine more alkaline before the uric
acid stone starts to dissolve.

32. THANK YOU FOR
YOUR ATTENTİON