Kidney stones

1. MR. MOUNESH. D. BADIGER
SENIOR TUTOR
MEDICAL SURGICAL DEPARTMENT
KAHER INSTITUTE OF NURSING SCIENCES,
BELAGAVI,
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2. DEFINITION
 Renal calculi also known as urolithiasis.
It is a kidney stone disease where a
solid piece of material (kidney stone)
occurs in the urinary tract.
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3. ETIOLOGY
Idiopathic
Super saturation of urine.
Obstruction with urinary
stasis
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4.  Urinary tract infection
 Medications may induce calculus
formation,
(e.g., calcium carbonate and sodium
bicarbonate, and aluminum hydroxide).
 Massive dose of vitamin C increases
urinary oxalate levels
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ETIOLOGY
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5. RISK FACTORS
 Immobility and sedentary lifestyle
 Dehydration, which leads to super
saturation.
 Previous history of urinary calculi.
 Imbalance of pH in urine.
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6. RISK FACTORS (CONTD…)
Metabolic disturbances that result
in an increase in calcium or other
ions in the urine.
 Dietary intake
 Gout ( Normal Uric acid levels are
2.4-6.0 mg/dL (female) and 3.4-
7.0 mg/dL (male).)
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7. RISK FACTORS (CONTD…)
High mineral content in drinking
water.
A diet high in purines, oxalates,
calcium supplements, animal
proteins.
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8. RISK FACTORS (CONTD…)
Prolonged indwelling catheterization.
Neurogenic bladder ( Flaccid or
spastic)
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10. CALCIUM OXALATE
Incidence (%): 35-40
Color: Black/dark brown
Sensitivity: Radio-opaque
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11. CALCIUM PHOSPHATE
Incidence (%): 8-10
Color: Dirty white
Sensitivity: Radio opaque
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12. STRUVITE (MAGNESIUM
AMMONIUM PHOSPHATE)
Incidence (%): 10-15%
Color: Dirty white
Sensitivity: Radio opaque
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13. URIC ACID
Incidence (%): 5-8
Color: Yellow/reddish brown
Sensitivity: Radiolucent
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14. CYSTINE
Incidence (%): 1-2
Color: Pink/Yellow
Sensitivity: Radio-opaque
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15. PATHOPHYSIOLOGY
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16. Saturation
Super saturation
Nucleation ( liquid to solid)
Crystal growth and aggregation
(hard mass)
Crystal retention
Stone formation
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17. Calcium and oxalate come
together to make the tiny
crystals.
Supersaturation promotes
their combination
Continued deposition at the
renal papillae leads to growth
of the kidney stones.
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18. Kidney stones grow and
collect debris .
The kidney stones block
all routes to the renal
papillae
The complete stone forms
and retention occurs.
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20. CLINICAL MANIFESTATION
Severe radiating flank pain ( sudden onset)
Dysuria
Cloudy or foul smelling urine
Dribbling of micturation
Anuria
Oliguria
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21.  Nausea
Vomiting
Elevated blood pressure and
pulse,
Diaphoresis
 Infection
 Mild fever with chills
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CLINICAL MANIFESTATION
(cont.…)
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22. CLINICAL MANIFESTATION
(CONT.…)
Urgency,
Frequency,
Pyuria
Hematuria
Leukocytosis and ESR.
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24. DIAGNOSTIC STUDIES
History collection
Physical examination
Inspection
Palpation
Percussion
Auscultation
Imaging Studies
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25. DIAGNOSTIC STUDIES
(CONTD…)
CT scan or MRI
may be used to differentiate a
nonopaque stone from a tumor.
Urine analysis
Urine examination, Culture &
sensitivity,24 hrs urine collection
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26. Hematological studies
The serum calcium,
phosphorus, magnesium,
bicarbonate, Uric acid, BUN,
RFT and CBC.
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DIAGNOSTIC STUDIES (CONTD…)
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Abdomen and renal ultrasound will
identify larger, radiopaque stones.
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IVP or retrograde pyelogram is used to
localize the degree and site of obstruction or
to confirm the presence of a radiolucent
stone.
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30. MEDICAL MANAGEMENT
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31. Watchful waiting or
hydrotherapy.
Diuretics
Narcotic analgesia.
PPI
Syp. Cital - Alkalinizing
agent
Antibiotics
Antacids
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32. Implement Dietary Changes.
Antiemetic
Mild sedatives if pain is severe
Loop diuretics
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33. MEDICATIONS TO PREVENT OR
DISSOLVE THE CALCULI
D-penicillamine, captropril for cystine
calculi
Pyridoxine or cholestryamine to prevent
oxalate stone
Allopurinol for uric stone
Hydrochlorthiazide, potassium citrate to
prevent calcium oxalate calculi
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34. SURGICAL
MANAGEMENT
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35. PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IS A
MINIMALLY-INVASIVE PROCEDURE TO REMOVE STONES FROM
THE KIDNEY BY A SMALL PUNCTURE WOUND THROUGH THE
SKIN. IT IS MOST SUITABLE TO REMOVE STONES OF MORE
THAN 2 CM IN SIZE AND WHICH ARE PRESENT NEAR THE
PELVIC REGION.
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36. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL)
IS A TYPE OF TREATMENT FOR KIDNEY STONES. IT USES
HIGH-ENERGY SHOCK WAVES TO BREAK DOWN THE KIDNEY
STONES INTO SMALL CRYSTALS.
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37. URETEROLITHOTOMY REFERS TO THE OPEN
OR LAPAROSCOPIC SURGICAL REMOVAL OF A
STONE FROM THE URETER.
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38. NEPHROSCOPY IS A NON-SURGICAL WAY OF EXAMINING THE
INSIDE OF THE KIDNEYS AND TREATING CERTAIN CONDITIONS
IN THE UPPER URINARY TRACT. THE THIN, FLEXIBLE TUBE PART
OF THE NEPHROSCOPE IS INSERTED INTO THE SKIN THROUGH A
VERY SMALL CUT.
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39. CYSTOLITHOTOMY IS A UROLOGIC PROCEDURE TO REMOVE
ONE OR MORE BLADDER STONES. IT IS TYPICALLY PERFORMED
FOR A PATIENT WITH LARGE OR NUMEROUS BLADDER STONES
OR IF AN ENDOSCOPIC APPROACH HAS NOT BEEN SUCCESSFUL
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40. VESICOLITHOTOMY IS GENERALLY PERFORMED IN
PATIENTS WITH AN IMPASSABLE OR SURGICALLY
ABLATED URETHRA.
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41. ELECTROHYDRAULIC LITHOTRIPSY
IS USES AN ELECTROHYDRAULIC DEVICE WITH A
FLEXIBLE PROBE TO DELIVER ELECTRICITY THAT
BREAKS APART THE STONES.
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42. URETERAL DOUBLE J (DJ) STENTS
A URETERAL STENT, OR URETERIC STENT, IS A THIN TUBE
INSERTED INTO THE URETER TO PREVENT OR TREAT
OBSTRUCTION OF THE URINE FLOW FROM THE KIDNEY
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43. COMPLICATIONS
Kidney failure
Urosepsis.
Haematuria
Uropathy
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