Calcium oxalate and calcium phosphate stones are the most common types in children. Risk factors include hypercalciuria, hyperoxaluria, hypocitraturia, cystinuria, and renal tubular acidosis. Struvite stones form due to urinary tract infections while uric acid stones are caused by hyperuricosuria. Treatment depends on stone location and size, and involves medications to address the underlying metabolic abnormality, increased fluid intake, and sometimes surgical removal by lithotripsy or ureteroscopy. Ongoing management focuses on prevention of recurrence through dietary modifications and medications that reduce stone-forming substance levels in urine.
Nephrolithiasis, commonly known as kidney stones, refers to the formation of hard mineral and salt deposits within the kidneys or urinary tract. These stones can vary in size, ranging from tiny grains to larger, more substantial formations. Nephrolithiasis is a relatively common condition and can affect people of all ages, although it is more prevalent in adults.
continuation on the urinary tract disorders. congenital and acquired disorders well covered. pyelonephritis also forms part of the text. thanks for reading. remeber to like and follow
Nephrolithiasis, commonly known as kidney stones, refers to the formation of hard mineral and salt deposits within the kidneys or urinary tract. These stones can vary in size, ranging from tiny grains to larger, more substantial formations. Nephrolithiasis is a relatively common condition and can affect people of all ages, although it is more prevalent in adults.
continuation on the urinary tract disorders. congenital and acquired disorders well covered. pyelonephritis also forms part of the text. thanks for reading. remeber to like and follow
Nephrolithiasis refers to stones (calculi) in kidney when urinary concentration of substances such as calcium oxalate, calcium phosphate and uric acid increases, but they can form in or migrate to the lower urinary system. They are typically asymptomatic until they pass into the lower urinary tract.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Nephrolithiasis refers to stones (calculi) in kidney when urinary concentration of substances such as calcium oxalate, calcium phosphate and uric acid increases, but they can form in or migrate to the lower urinary system. They are typically asymptomatic until they pass into the lower urinary tract.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. CLASSIFICATION OF UROLITHIASIS
1.CALCIUM STONES(CALCIUM OXALATE AND CALCIUM PHOSPHATE)
Causes:
-hypercalciuria
-absorptive: increased Ca absorption from gut
-renal leak : decreased tubular reabsorption of Ca
-primary hyperparathyroidism (rare in children)
-iatrogenic
-loop diuretics
-ketogenic diet
7. STONE FORMATION
• Stone formation depends on 4 factors:
1. matrix
2. precipitation–crystallization
3. epitaxy
4. absence of inhibitors of stone formation in the urine.
8. 1.Matrix :
It is a mixture of protein, non amino sugars, glucosamine, water, and
organic ash that makes up 2-9% of the dry weight of urinary stones and
is arranged within the stones in organized concentric laminations.
2.Precipitation–crystallization
It refers to supersaturation of the urine with specific ions composing
the crystal. Crystals aggregate by chemical and electrical forces.
Increasing the saturation of urine with respect to the ions increases the
rate of nucleation, crystal growth, and aggregation and increases the
likelihood of stone formation and growth
9. 3. Epitaxy
It refers to the aggregation of crystals of different composition but
similar lattice structure, thus forming stones of a heterogeneous
nature.
The lattice structures of calcium oxalate and monosodium urate have
similar structures, and calcium
oxalate crystals can aggregate on a nucleus of monosodium urate
crystals.
10. 4.Inhibitors of stone formation are :
Inorganic :
eg: -Citrate
-Magnesium
Organic
eg: -Glycosaminoglycans
-osteopontin
11. PATHOGENESIS OF SPECIFIC RENAL CALCULI
CALCIUM OXALATE AND CALCIUM PHOSPHATE CALCULI
• Most urinary calculi in children are composed of calcium oxalate
and/or calcium phosphate.
• The most common metabolic abnormality in these patients is
normocalcemic hypercalciuria.
• Between 30% and 60% of children with calcium stones have
hypercalciuria without hypercalcemia.
12. • Other metabolic aberrations that predispose to stone disease include
-hyperoxaluria,
- hyperuricosuria
-hypocitruria
-heterozygous cystinuria
-hypomagnesuria
- renal tubular acidosis
14. 1. Absorptive hypercalciuria :
- The primary disturbance in absorptive hypercalciuria is intestinal
hyperabsorption of calcium.
- In some children, an increase in 1,25-dihydroxyvitamin D is associated
with the increased calcium absorption, whereas in others the process
is independent of vitamin D.
15. 2.Renal hypercalciuria :
- It refers to impaired renal tubular reabsorption of calcium
- Renal leak of calcium causes mild hypocalcemia, which triggers an
increased production of parathyroid hormone, with increased
intestinal absorption of calcium and increased mobilization of calcium
stores
16. 3.Resorptive hypercalciuria
It is uncommon and is found in patients with primary
hyperparathyroidism. Excess parathyroid hormone secretion stimulates
intestinal absorption of calcium and mobilization of calcium stores.
17. HYPEROXALURIA :
• It is another potentially important cause of calcium stones. Oxalate
increases the solubility product of calcium oxalate crystallization 7-10
times more than calcium. Consequently, hyperoxaluria significantly
increases the likelihood of calcium oxalate precipitation.
• Oxalate is found in high concentration in tea, coffee, spinach, and
rhubarb
18. HYPOCITRATURIA :
• citrate is an important inhibitor of calcium stone formation.
• Citrate acts as an inhibitor of calcium urolithiasis by forming
complexes with calcium, increasing the solubility of calcium in the
urine, and inhibiting the aggregation of calcium phosphate and
calcium oxalate crystals.
• Disorders such as chronic diarrhea, intestinal malabsorption, and
renal tubular acidosis can cause hypocitraturia. It may also be
idiopathic.
19. RENAL TUBULAR ACIDOSIS (RTA) :
• In type 1 RTA, the distal nephron does not secrete hydrogen ion into
the distal tubule.
• The urine pH is never <5.8 and hyperchloremic hypokalemic acidosis
results.
• Patients acquire nephrolithiasis,nephrocalcinosis,muscle weakness
and osteomalacia
20. CYSTINE CALCULI :
• Cystinuria accounts for 1% of renal calculi in children.
• The condition is a rare autosomal recessive disorder of the epithelial
cells of the renal tubule that prevents absorption of the 4 dibasic
amino acids (cystine, ornithine, arginine, lysine)
• it results in excessive urinary excretion of these products.
• The only known complication of this familial disease is the formation
of calculi, because of the low solubility of cystine.
21. • In the homozygous patient, the daily excretion of cystine usually
exceeds 500 mg, and stone formation occurs at an early age.
• Heterozygotes excrete 100-300 mg/day and typically do not have
clinical urolithiasis.
• The sulfur content of cystine gives these stones their faint
radiopaque appearance
22. STRUVITE CALCULI
• Urinary tract infections caused by urea-splitting organisms most
often Proteus spp.,
• it result in urinary alkalinization and excessive production of
ammonia, which can lead to the precipitation of magnesium
ammonium phosphate (struvite) and calcium phosphate.
• In the kidney, the calculi often have a staghorn configuration, filling
the calyces. The calculi act as foreign bodies, causing obstruction,
perpetuating infection, and causing gradual kidney damage.
23. • Patients with struvite stones also can have metabolic abnormalities
that predispose to stone formation.
• These stones often are seen in children with neuropathic bladder,
particularly those who have undergone a urinary tract reconstructive
procedure .
• Struvite stones also can form in the reconstructed bladder of children
who have undergone augmentation cystoplasty or continent urinary
diversion
24. URIC ACID CALCULI :
• Hyperuricosuria with or without hyperuricemia is the common
underlying factor in most cases.
• The stones are radiolucent on x-ray.
• The diagnosis should be suspected in a patient with persistently acid
urine and urate crystalluria.
• Hyperuricosuria can result from various inborn errors of purine
metabolism that lead to overproduction of uric acid, the end product
of purine metabolism in humans.
25. • Children with the Lesch-Nyhan syndrome and patients with glucose-
6-phosphatase deficiency form urate calculi as well.
• In children with short-bowel syndrome and particularly those with
ileostomies, chronic dehydration and acidosis sometimes are
complicated by uric acid lithiasis
26. INDINAVIR CALCULI :
• Indinavir sulfate is a protease inhibitor approved for treating HIV
infection .
• Up to 4% of patients acquire symptomatic nephrolithiasis.
• Most of the calculi are radiolucent and are composedof indinavir-
based monohydrate, although calcium oxalate and/or phosphate have
been present in some.
27. • The urine in these patients often contains crystals of characteristic
rectangles and fan-shaped or starburst crystals. Indinavir is soluble at
a pH of
• Consequently, dissolution therapy by urinary acidification with
ammonium chloride or ascorbic acid should be considered.
28. NEPHROCALCINOSIS :
• Nephrocalcinosis refers to calcium deposition within the renal tissue.
Often nephrocalcinosis is associated with urolithiasis.
• The most common causes are furosemide (administered to
premature neonates), distal RTA, hyperparathyroidism, medullary
sponge kidney, hypophosphatemic rickets, sarcoidosis, cortical
necrosis, hyperoxaluria, prolonged immobilization, Cushing syndrome,
hyperuricosuria, monogenetic causes of hypertension, and renal
candidiasis
29. CLINICAL MANIFESTATIONS
• Children with urolithiasis usually have gross or microscopic
hematuria.
• If the calculus causes obstruction, then severe flank pain (renal colic)
or abdominal pain occurs.
• The calculus typically causes obstruction at areas of narrowing of the
urinary tract—the ureteropelvic junction, where the ureter crosses
the iliac vessels, and the ureterovesical junction.
30. • Typically the pain radiates anteriorly to the scrotum or labia.
• Often the pain is intermittent, corresponding to periods of
obstruction of urine flow, which increases the pressure in the
collecting system.
• If the calculus is in the distal ureter, the child can have irritative
symptoms of dysuria, urgency, and frequency.
31. • If the stone passes into the bladder, the child usually is asymptomatic.
• If the stone is in the urethra, dysuria and difficulty voiding can result,
particularly in boys.
• Some children pass small amounts of gravel-like material.
• Stones can also be asymptomatic, although it is uncommon to pass a
ureteral calculus without symptoms.
32. DIAGNOSIS
• Approximately 90% of urinary calculi are calcified to some degree and
consequently are radiopaque on a plain abdominal film.
• Struvite (magnesium ammonium phosphate) stones are radiopaque.
• Cystine, xanthine, and uric acid calculi may be radiolucent but often
are slightly opacified.
33. • In a child with suspected renal colic, there are multiple imaging
options. The most accurate study is an unenhanced spiral CT scan of
the abdomen and pelvis
• This study takes only a few minutes to perform, has 96% sensitivity
and specificity in delineating the number and location of calculi
• it demonstrates whether the involved kidney is hydronephrotic.
• However, the radiation exposure is high.
34.
35. • An alternative is to obtain a plain radiograph of the abdomen and
pelvis plus a renal ultrasonogram.
• These studies can demonstrate hydronephrosis and possibly the
calculus on the radiograph
• however, the calculus is not visualized on sonography unless it is
adjacent to the bladder.
36.
37. • In addition, renal calculi <3mm are typically not seen
• Consequently, the clinician needs to carefully balance the risks of CT
imaging against the lower sensitivity of the plain abdominal film plus
sonography
38. METABOLIC EVALUATION
• A metabolic evaluation for the most common predisposing factors
should be undertaken in all children with urolithiasis .
• As the structural, infectious, and metabolic factors often coexist.
• This evaluation should not be undertaken in a child who is in the
process of passing a stone, because the altered diet and hydration
status, as well as the effect of obstruction on the kidney, can alter the
results of the study.
39. • In children with hypercalciuria, further studies of calcium excretion
with dietary calcium restriction and calcium loading are necessary
40.
41. TREATMENT
• In a child with a renal or ureteral calculus, the decision whether to
remove the stone depends on its location, size, and composition (if
known)
• and whether obstruction and/or infection is present.
• Pain is managed with nonsteroidal anti inflammatory drugs or
opiates.
• Small ureteral calculi often pass spontaneously, although the child
might experience severe renal colic
42. • α-Adrenergic blockers, such as tamsulosin, terazosin, and doxazosin,
facilitate stone passage in children and adults by decreasing ureteral
pressure below the stone and decreasing the frequency of the
peristaltic contractions of the obstructed ureter.
• In many cases, passage of a ureteral stent past the stone
endoscopically relieves pain and dilates the ureter sufficiently to allow
the calculus to pass.
43. • In cases such as children with a uric acid calculus or an infant with a
furosemide-associated calculus, dissolution alkaline therapy may be
effective.
• If the calculus does not pass or seems unlikely to pass or if there is
associated urinary tract infection, removal is necessary
44. • Lithotripsy of bladder, ureteral, and small renal pelvic calculi using the
holmium laser through a flexible or rigid ureteroscope is quite
effective.
• Extracorporeal shock wave lithotripsy has been successfully applied
to children with renal and ureteral stones, with a success rate of
>75%.
45. • Another alternative is percutaneous nephrostolithotomy,
• in which access to the renal collecting system is obtained
percutaneously, and the calculi are broken down by ultrasonic
lithotripsy.
• In cases in which these modalities are unsuccessful, an alternative is
laparoscopic removal; this procedure can be performed using the da
Vinci robot.
46.
47. • In children with urolithiasis, the underlying metabolic disorder should
be addressed
• Because lithiasis results from elevated concentrations of specific
substances in the urine, maintaining a continuous high urine output
by maintaining a high fluid intake often is an effective method of
preventing further stones.
• The high fluid intake should be continued at night, and usually it is
necessary for the child to get up at least once at night to urinate and
drink more water.
48. • High sodium intake increases urinary excretion of calcium and may
result in hypocitraturia.
• In addition, increased salt intake induces metabolic acidosis. To
compensate for the acid load, the kidneys conserve anions, including
urinary citrate, which contributes to hypocitraturia.
• Reduction in dietary intake of sodium and increased potassium intake
is indicated
49. • Low sodium, low-protein diets reduce urinary calcium and oxalate
excretion.
• Children with stone disease should avoid excess calcium intake.
However, children require calcium for bone development and
recommendations for daily calcium intake vary by age.
• Consequently, calcium restriction in children should be avoided.
• Thiazide diuretics also reduce renal calcium excretion.
50. • Addition of potassium citrate, an inhibitor of calcium stones, with a
dosage of 1-2 mEq/kg/24 hr is beneficial.
51. • In patients with uric acid stones, allopurinol is effective.
• Allopurinol is an inhibitor of xanthine oxidase and is effective in
reducing the production of both uric acid and 2,8-dihydroxyadenine
and can help control recurrence of both types of stones.
• In addition, urinary alkalinization with sodium bicarbonate or sodium
citrate is beneficial.
• The urine pH should be ≥6.5 and can be monitored at home by the
family
52. • Maintaining a high urine pH can also prevent recurrence of cystine
calculi.
• Cystine is much more soluble when the urinary pH is >7.5, and
alkalinization of urine with sodium bicarbonate or sodium citrate is
effective.
• Another important medication is d-penicillamine, which is a chelating
agent that binds to cysteine or homocysteine, increasing the solubility
of the product.