Kidney stones, also known as renal calculi, form when substances in urine crystallize and accumulate in the kidneys or urinary tract. The document discusses the types of kidney stones including calcium oxalate, uric acid, struvite, and cystine stones. It also outlines risk factors for stone formation such as urinary pH, infections, diet, and genetic disorders. Treatment involves increasing fluid intake, managing underlying conditions, and sometimes surgical procedures like lithotripsy to break up larger stones.

1. KIDNEY STONES
FAZAIA (PAF) COLLEGE LAHORE
Presented By
EJAZ KHICHI
M.Sc ; B.Ed : M.Sc (Env. Sc.) Micro-Biology
Former Visiting Faculty PGCES , CIMR (PU)
Ex Vice Principal Fazaia (PAF) College Lahore
Head of Biology Deptt. Fazaia (PAF) College Lahore
BIOLOGY HSSC – II LBISE Chap. 15 PTB

2. KIDNEY STONES
The accumulation of a variety of sediments in the Kidney
which cause/s the Urinary Obstructions and Bleeding in the
Renal Path, as well as sudden onset of the severe, stubbed
and intermittent Abdominal Pain, Flank or Groin, due to the
decreased Urine Volume or increased Excretion of the Stone-
Forming Components like that of Calcium, Oxalate, Urate,
Cystine, Xanthine, Phosphate etc
BIOLOGY HSSC – II LBISE Chap. 15 PTB
Flank :- A cut from the fleshy part of an
animal’s side B/W the Ribs and the Legs
Groin:- The crease at the junction of the
inner part of the thigh with the trunk
together with the adjacent region and often
including the external genitalia

3. STONE EVALUATION
Multichannel Blood Screening
• Basic Metabolic Panel (Sodium, Potassium, Chloride, Carbon dioxide,
Blood Urea Nitrogen, Creatinine)
• Calcium • Intact parathyroid hormone • Uric acid
Urine Analysis
• pH > 7.5: Infection Lithiasis (Stone Formation in an internal organ)
• pH < 5.5: Uric Acid Lithiasis
• Sediment for Crystalluria
Urine Culture
• Urea-Splitting Organisms:-
Suggestive of Infection Lithiasis
• Qualitative Cystine
Stone Analysis
BIOLOGY HSSC – II LBISE Chap. 15 PTB

4. Urolithiasis
BIOLOGY HSSC – II LBISE Chap. 15 PTB
The condition where urinary stones are formed or located anywhere in the
Urinary system
- Nephrolithiasis (Renal Calculus) refers to the stones that are in the
Kidney
- Ureterolithiasis refers to stones that are in the Ureter
- Cystolithiasis (Vesical Calculi) refers to stones which form or have
passed into the Urinary Bladder
• Kidney Stones are composed of the Metabolic Products,
present in the Glomerular Filtrate, in high concentrations

5. Urolithiasis
- KIDNEY STONES
- URETERAL STONES
- BLADDER STONES
- URETHRAL STONES
BIOLOGY HSSC – II LBISE Chap. 15 PTB

6. Conditions which cause
Kidney Stone Formation
BIOLOGY HSSC – II LBISE Chap. 15 PTB
- High Concentration of the Metabolites in the Glomerular Filtrate
- Changes in the Urine pH
- Urinary Stagnation
- Deficiency of Stone-forming Inhibitors in the Urine
☼ High Concentration of the Metabolites
in the Glomerular Filtrate
- Low Urinary Volume (with Normal Renal Function) due to the restricted
Fluid Intake
- Increased Fluid Loss from the Body of an Individual
- Increased Excretion of Metabolic Products forming Stones
- High Plasma Volume (High Filtrate Level)
- Low Tubular Reabsorption from the Filtrate

7. Conditions which cause
Kidney Stone Formation
☼ Change in Urine pH
- Bacterial Infection
- Precipitation of the Salts at different pH
BIOLOGY HSSC – II LBISE Chap. 15 PTB
☼ Urinary Stagnation
- Obstruction of the Urinary flow
☼ Deficiency of Stone-forming Inhibitors in the
Urine
- Citrate, Pyrophosphate, Glyco-Proteins inhibit growth of Calcium
Phosphate and Calcium Oxalate Crystals
- In type - I Renal Tubular Acidosis, Hypo-Citraturia leads to the Renal
Stone Formation

8. Epidemiology
The Lower the Economic Status, the Lower the likelihood of the
Renal Stones
- Mostly at the age of 20-49 years
- Peak incidence at the age of 35-45 years
- Male-to-Female Ratio of 3:1
BIOLOGY HSSC – II LBISE Chap. 15 PTB
Urolithiasis occurs in all parts of the world
A Lifetime Risk : -
- 2-5% for Asia
- 8-15% for the West
- 20% for the Kingdom of Saudi Arabia
- Hot Climate
- Dietary Habits
- Hereditary Factors

9. BIOLOGY HSSC – II LBISE Chap. 15 PTB
Kidney
Stone
Type
Effect
- ed
Popu -
Lation
Circumstances Details
Calcium
Oxalate 80%
Alkaline Urine
(pH>5.5)
Some of the Oxalate in urine, is produced
by the body. Calcium and Oxalate in the
diet play a part but are not the only factors
that affect the formation of Calcium
Oxalate Stones. Dietary Oxalate is an
organic molecule found in many vegetable
fruits and nuts. Calcium from the bones
may also play a role in the Kidney Stone
Formation
Calcium
Phosphate
5-10% Alkaline Urine
(High pH)
Stag-Horn in the Renal Pelvis (Large)
KIDNEY STONES & THEIR TYPES

10. KIDNEY STONES & THEIR TYPES
Uric Acid 5-10%
Persistently
Acidic Urine
Diets rich in animal Proteins and Purines
substances found naturally in all food but
especially in the organ meats, fish and
Shellfish
Struvite 10-15% Kidney Infection
Preventing Struvite Stones depends on
staying Infection-Free. Diet has not been
shown to affect Struvite Stone Formation.
These are the Magnesium Ammonium
Phosphate Stones
Cystine 1-2%
Genetic
Disorder
(Rare)
Cystine, an Amino Acid (one of the
Building Blocks of the Proteins), leaks
through the Kidneys and into the Urine to
form the Crystals
Kidney
Stone
Type
Effect
- ed
Popu -
Lation
Circumstances Details
BIOLOGY HSSC – II LBISE Chap. 15 PTB

11. Calcium Salt Stones
80% of the Kidney Stones contain Calcium
- The type of Calcium Salt depends on • Urine pH • Availability of Oxalate
- General Appearance:- • White, Hard, Radio-Opaque
• Calcium Phosphate :- Stag-Horn in the Renal Pelvis (Large)
• Calcium Oxalate :- Present in the Ureter (Small)
Causes of Calcium Salt Stone Formation : - Hyper-Calciuria
• Increased Urinary Calcium Excretion
• Men: > 7.5 mmols/day • Women > 6.2 mmols/day
• May or may not be due to Hyper-Calcemia
Hyper - Oxaluria
• Causes the formation of Calcium Oxalates without Hyper-Calciuria
• Diet rich in Oxalates
• Increased Oxalate absorption in the Fat mal-absorption
Primary Hyper - Oxaluria
• Due to Inborn Errors
• Urinary Oxalate Excretion: > 400 mmols/day

12. Calcium Salt Stone
TREATMENT
Treatment of Primary Causes
such as Infections, Hyper-Calcemia, Hyper-Oxaluria
• Oxalate-Restricted Diet • Increased Fluid Intake
• Acidification of Urine (By Dietary Changes)
• Calcium Salt Stones are formed in Alkaline Urine
BIOLOGY HSSC – II LBISE Chap. 15 PTBBIOLOGY HSSC – II LBISE Chap. 15 PTB

13. Uric Acid Stones
About 8% of the Renal Stones contain Uric Acid
• May be associated with Hyperuricemia (with or without Gout)
• Form in Acidic Urine
General Appearance:-
• Small, Friable, Yellowish
• May form Stag-Horn
• Radiolucent (Plain X-rays cannot detect)
• Visualized by Ultrasound or Pyelogram
Treatment
- Purine Restricted Diet - Alkalinization of Urine
- Increased Fluid Intake
BIOLOGY HSSC – II LBISE Chap. 15 PTB

14. Mg NH4 PO4 Stones
About 10% of all the Renal Stones contain Mg NH4 PO4
- Also called Struvite Kidney Stones
- Associated with Chronic Urinary Tract Infection
• Microorganisms (such as from Proteus Genus) metabolize Urea into
Ammonia
• Causes the Urine pH to become Alkaline and results in the Stone formation
• Commonly associated with Stag-Horn Calculi
• 75% of the Stag-Horn Stones are of Struvite type
BIOLOGY HSSC – II LBISE Chap. 15 PTB
Treatment
- Treatment of Infection - Acidification of Urine
- Increased Fluid Intake

15. Cystine Stones
- A Rare type of the Kidney Stone
• Formed due to the Homozygous Cystinuria
• Formed in the Acidic Urine • Soluble in the Alkaline Urine
• Faint Radio-opaque
Treatment
- Increased Fluid Intake
- Alkalinization of Urine (by the Dietary Changes)
- Use of Penicillamine which binds to Cysteine to form a compound more
Soluble in water than the Cystine

16. Physical Exam
BIOLOGY HSSC – II LBISE Chap. 15 PTB
Dramatic Costovertebral Angle-tenderness
- Unremarkable Abdominal Evaluation
- Painful Testicles but normal-appearing
- Constant Body Positional movements
(e.g,, Writhing, Pacing)
- Tachycardia
- Hypertension
- Microscopic Hematuria

17. Emergency Renal Colic
- Fluid Intake (Hydration)
Analgesics
- Paracetamol
- NSAID
- Opiod
- Antiemetic
In case of Infection
- Urine Culture
- Blood Culture accordingly
- Antibiotics Administration
BIOLOGY HSSC – II LBISE Chap. 15 PTB

18. LITHOTRIPSY
The breaking down of the Calculi (Stones) in the Urinary System with the
help of Shock Waves or the Crushing of Kidney’s Stones with the help of the
Surgical Instruments into very small pieces, enough to be voided or washed
out of the of the Kidneys (1834)
Lithotripsy is actually the Non-Surgical removal of the Kidney stones,
even in Ureter as well as in the Gall Bladder
The common method followed is the
Extracorporeal Shock Wave Lithotripsy
High Concentration of X-rays or ultrasound are directed from a machine outside the
body to the stone inside
The Shock Waves break the Stone into tiny pieces or even into Sand, which pass
away from the body of an individual, through its Urine
RENAL FAILURE
Various Pathological and Chemical Factors, progressively destroy the Nephrons
Particularly the Glomerular Part of the Nephrons is destructed which results in the
Increase of Plasma Level and other Nitrogenous Wastes in the Urea
This Rise in Urea, causes the Complications like that of Increased Blood Pressure
and Anaemia etc
BIOLOGY HSSC – II LBISE Chap. 15 PTB

19. BIOLOGY HSSC – II LBISE Chap. 15 PTB
KIDNEY STONES
Presented By
EJAZ KHICHI
M.Sc ; B.Ed : M.Sc (Env. Sc.) Micro-Biology
Former Visiting Faculty PGCES , CIMR (PU)
Ex Vice Principal Fazaia (PAF) College Lahore
Head of Biology Deptt. Fazaia (PAF) College Lahore