The document discusses renal stone diseases (nephrolithiasis) covering their etiology, symptoms, and management strategies. Types of stones include calcium oxalate, uric acid, and struvite, with conditions like idiopathic calcium urolithiasis and various hypercalcemic disorders listed as causes. Management can be emergency or elective, using interventions such as extracorporeal shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.

1. Renal Stone
Diseases
M.Hudaib
202086

2. Learning objectives
 Introduction and Etiology of renal stone
diseases
 History taking
 Examination
 Differentials
 Management

3. Renal Calculi
 Called nephrolithiasis or urolithiasis
 Most commonly develop in the renal pelvis
but can be anywhere in the urinary tract
 May stay in kidney or urinary tract
 May stay in kidney or travel to the ureter
 May cause hydronephrosis

4. Types of stones
Pure
Calcium
Oxalate
Mixed
Calcium
Oxalate and
Phosphate
Magnesium
Ammonium
Phosphate
(Struvite)
Uric Acid Cystine

5. Renal
Stone
Diseases
Idiopathic
Calcium
Urolithiasis
Hypercalce
mic
Disorders
Renal
Tubular
syndromes
Uric acid
Lithiasis
Enzyme
Disorders
Secondary
Urollithiasi
s
Other
factors
Etiology of Renal Stone Diseases

6. Etiology (continued)
Idiopathic calcium
urolithiasis
Unexplained
hypercalciuria
Normal serum calcium
Can be renal or
Absorptive
70 percent of urinary
tract stones

7. Etiology (continued)
Hypercalcemic
disorders
1. Primary Hyperparathyroidism
 Due to parathyroid Adenoma
 Increased production of 1,25
dihydroxycholecalciferol
 Increased intestinal and renal
Ca2+ tubular reabsorption
 < 5 percent of people with radio-
opaque stones

8. 2. Prolonged Immobilization
 Hypercalcemia and hypercalciuria
from bone resorption
3. Milk – Alkali Syndrome
 Ingestion of large quantities of
Ca2+, Vitamin D and Alkali results
in hypercalcemia, alkalosis and
possible renal impairment
 Compromised renal excretion of
Ca2+ promoting soft tissue
calcification
4. Sarcoidosis
 Non – Caseating granulomata
produce 1,25
dihydroxycholecalciferol

9. Etiology ( continued)
Renal Tubular
Acidosis (RTA)
3 types of RTA , which
is due to hypercalciuria
and low urinary citrate
Stones consist of
Calcium Phosphate
Cystinuria - Defect in
renal transport of
COAL. Stones are very
hard and radio-opaque

10. Etiology (continued)
Uric acid stones
 5-10 percent of urinary tract stones
 Due to excess amount of uric acid excretion or uric acid in insoluble form
Enzyme Disorders
 Primary Hyperoxaluria
 Xanthuria
 2,8 Dihydroadeninuria
Secondary Urolithiasis
 Secondary Hyperoxaluria
 Dietary Excess
 Infection
 Obstruction and Stasis

11. History taking
Age – mostly between 30 and 50 years
Sex – More common in men than in women
Season – Summer. Why ?
Symptoms : Pain
Hematuria
dysuria
Symptoms of acute pyelonephritis
symptoms associated with uraemia in severe cases such
as headaches, restlessness, twitching, fits, convulsions,
drowsiness and coma
Past medical history : UTI, gout, parathyroidism , IBD
Family History : gout and parathyroidism
Personal History : Water intake, Foods high in Oxalates, High Na+
and Ca+

12. Examination
Abdominal examination
Costovertebral angle tenderness
Differential Diagnosis
Acute Pyelonephritis
Renal cell carcinoma

14. Management of Stones in
emergency setting
 CT scan
 Stones in the distal ureter treated expectantly, medical expulsive treatment
maybe considered
 NSAIDs eg : diclofenac
 Monitor vitals and WBC count
 eGFR measurement
 For urgent pain :
• In situ ESWL
• Cystoscopy and inserting stent
• Primary ureteroscopic stone retrieval , lasertripsy

15. Management in elective setting
ESWL ( Extracorporeal
shockwave Lithotropsy)
Shockwaves generated
outside the body
Needs to be coordinated
with ECG
Prophylactic antibodies
are given
Cystine stones are
relatively resistant
Can result in hematuria

16. Management in Elective setting
Ureteroscopy
Used for
endoscopic
examination and
visualization
Stones then
retrieved by
wire retrieval
baskets

17. Management in Elective setting
Percutaneous Nephrolithotomy
(PCNL)
 Used to treat larger stones in the
renal pelvis or calyces or proximal
ureter
 Tract is established into the renal
collecting system
 Series of dilators is used through
which stone is visualised and
fragmented ( using ultrasound,
laser or lithocast)

18. Thank You