This document discusses urolithiasis (kidney stones) and pyelonephritis (kidney infection). It provides details on the epidemiology, causes, clinical presentation, diagnosis and treatment of both conditions. Kidney stones are most commonly calcium-based and affect 10% of the population. Presentation includes flank pain, nausea and hematuria. Diagnosis is via CT scan and treatment involves shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotomy. Pyelonephritis is a bacterial kidney infection usually from ascending infection. It causes fever, flank pain and urinary symptoms. Treatment is hospitalization and IV antibiotics for severe cases or oral antibiotics otherwise.

1. UROLITHIASIS
SUDHARSHINI PRIZKILLA
GROUP-11

2. • Urolithiasis is also called as Kidney stones,Renal Stones or Renal
Caliculi.
• Urolithiasis, or urinary calculus disease, may affect up to 10% of the
population over the course of a lifetime
• Calculi are crystalline aggregates of one or more components, most
commonly calcium oxalate.

3. • The epidemiology of urolithiasis differs according to geographical area
in term of prevalence and incidence, age and sex distribution, stone
composition and stone location.
• Epidemiological surveys have been previously reviewed showing that
in economically developed countries the prevalence rate ranged
between 4% and 20% .
• Approximately 50% of patients present between the ages of 30 and
50 years
• There is a slight male preponderance. Male :Female = 3:1
• The increasing incidence of nephrolithiasis in women might be due to
lifestyle associated risk factors, such as obesity.

4. • CALCIUM STONES 70-80%
Calcium Phosphate 5-10%
Calcium Oxalate 30-35%
Calcium Oxalate 20-30%
• Struvite stones15-20%
• Cystinestones -3%
• Uric acidstones

5. • There are very many causes for urinary tract stone disease
which can be classified into the following groups:
• Idiopathic calcium urolithiasis: This is present in approximately 70% of
patients with urinary tract infections
• Hypercalcaemic Disorders:
PRIMARY HYPERPARATHYROIDISM
PROLONGED IMMOBILISATION
MILK-ALKALI SYNDROME
SARCOIDOSIS

6. • RENAL TUBULAR SYNDROMES
RENAL TUBULAR ACIDOSIS (RTA)
CYSTINURIA
• URIC ACID LITHIASIS
• ENZYME DISORDERS
PRIMARY HYPEROXALURIA
XANTHINURIA
2, 8-DIHYDROADENINURIA

7. • DIETARY EXCESS
Rhubarb, spinach, tea, cocoa, chocolate and pepper commonly
increase urinary oxalate
• INFECTION
• OBSTRUCTION AND STASIS
• MEDULLARY SPONGE KIDNEY
• DRUGS:Acetazolamide stimulates renal tubular acidosis.
Allopurinol may precipitate xanthine stones. Thiazide diuretics
can result in uric acid stone formation.

8. OTHER FACTORS
• Other factors include:
• geography;
• climatic and seasonal factors;
• water intake;
• diet;
• occupation: especially sedentary jobs in hot environments

9. • Urinary calculi may occur anywhere in the urinary tract.
• They usually are asymptomatic in the renal pelvis or bladder, but
they are a very common cause of symptomatic ureteral obstruction
• Smaller stones (up to 6 mm) may cause severe symptoms, such as
flank pain and nausea
• Visible haematuria is rarely present but dipstick haematuria is a
frequent accompaniment to the pain

10. • Renal/Ureteral Colic(PAIN)
– Abrupt onset while asleeporat rest
– Crescendoof extremepain
– Flankradiating laterally and downward
to groin/testicle or round
ligament/labiamajora
– Impossibleto be still
• Mid ureter
– lateral flank andabdomen
• Lowerureter
– suprapubicandurethral
– urgencyandfrequency

11. • GISymptoms
– Nauseaand vomiting – autonomic n.s.
– Ileus or diarrhea
– DDX:gastroenteritis, appendicitis, colitis, diverticular disease and
salpingitis
• Hematuria
– grossor microscopic
– 15%no hematuria!
• Pyuria/Fever
– Pyuria even without infection
– Infection especially infemale

12. • The diagnosis of a urinary tract calculus is by with a non-contrast
CT scan
• A supplementary plain x-ray is often performed to
assess if the stone(s) are radio-opaque.
• Calcium- and struvite-containing stones often are
– visible on plain radiographs.Pure uric acid, indinavir-induced, and cystine
calculiare relatively radiolucent on plainradiography
• Patients with recurrent stones will benefit from examination
of stone composition and 24-hour urine metabolic workup to determine the
underlying etiology

13. NON
CONTRAST CT KUB

14. • The management of urinary tract stones can be subdivided depending on whether the
patient presents in the emergency or elective setting.
• In EMERGENCY SETTING,
small stones (<5 mm), especially in the distal ureter, are
treated expectantly as they are likely to pass spontaneously
The patient is usually given a non-steroidal anti-inflammatory drug such as
diclofenac for pain relief and observed for further episodes of pain, but also temperature,
pulse, blood pressure and white blood count are monitored for signs of developing
infection and the estimated glomerular filtration rate (eGFR) is monitored.

15. • Obstructing stones often are temporizedwith stent placement, which
allows proximal collecting system decompression.
• When urinary infection coexists with an obstructing stone, a stent can
be placed, but a PCN is preferable if the patient demonstrates any
instability.
• Definitive treatment of renal or ureteral calculi (lithotripsy) is through
ureteroscopy, percutaneous nephrostolithotomy (PCNL), or
extracorporeal shock wave lithotripsy (ESWL).

16. • Ureteroscopy is performed with
a flexible or semirigid device that
is passed to the level of the
calculus.
• Under direct visualization, a
laser fiber is passed through the
scope, and energy is delivered to
fragment the calculus.
• Fragments are extracted,
although they usually will pass
spontaneously. Ureteroscopy. X-ray showing a ureteroscope and guidewire in the
ureter

17. )
• PCNL is performed through a
percutaneous tract into the
kidney, where a larger scope
andvarious energy sources
(laser, ultrasound) are used to
fragment and aspirate large
renal calculi
• This approach is well suited to
staghorn calculi.
INDICATIONS
• Obese patients in whom ESWL is contraindicated.
contraindicated.
• 3Lower calyceal stones: these are less likely to pass
pass after ESWL.
• Stone composition: struvite stones need to be
be completely removed because of associated infection.
associated infection. As previously mentioned, some
mentioned, some stones with a very hard composition
composition are difficult to fragment using ESWL,
ESWL, including calcium oxalate monohydrate and
monohydrate and cystine stones
• An obstruction: anatomic abnormalities such as PUJ
such as PUJ obstruction, calyceal diverticula or ureteric
or ureteric obstruction might prevent the passage of
passage of stone fragments after ESWL

18. Percutaneous renal stone removal. (a) The stone is in the right renal pelvis. (b)
Placement of a cannula under radiologicalcontrol into the renal pelvis and through it
a balloon catheter to stopfragments migrating into the upper ureter. (c) The stone is
disrupted by contact lithotripsy and the fragments have been successfullyremoved
by irrigation. (d) A nephrostogram confirms that the renal pelvis is intact.

19. • ESWL is completely noninvasive and
uses a device that delivers
convergent shockwave energy to the
calculus under fluoroscopic
guidance.
• This is the common form of
treatment these days for renal
calculi and stones up to
approximately 1.5 cm in size are
suitable for this form of treatment.
• Cystine stones are relatively
resistant to ESWL due to their
hardness.
• ESWL may result in haematuria,
parenchymal haemorrhage and
even perirenal haematoma.
• Contraindications to ESWL are
obese patients, pregnant
patients and patients taking oral
anticoagulants.

22. PYELONEPHRITIS

23. • Pyelonephritis is a bacterial infection of the kidney.
• It is frequently attributed to ascending bacteria along the path of the
ureters and is rarely due to hematogenous bacterial spread.
• CAUSES:
• Vesicoureteric Reflux
• Kidney stones
• Urinary tract catheterization
• Pregnancy
• Diabetes Mellitus

24. • Patients typically present with flank pain and fevers
• young or elderly patients may not demonstrate these symptoms
but rather irritability, poor appetite, or altered mental status
• Frequent urination
• Strong, persistent urge to urinate
• Burning sensation or pain when urinating
• Nausea,Vomiting

25. • Urineanalysis may show sign of UTI
• Blood test
• Intravenous Pyelography
• Urinary tract imaging is not required
unless urinary obstruction or stones
are suspected or the patient is not
responding to antibiotics.
• Any patient who is not properly
responding to antibiotic therapy
after 72 hours should undergo CT
imaging to rule out an abscess
obstruction
• Urine culture

26. • Patients who are not septic and can tolerate fluids can be discharged
home on a 2-week course of oral antibiotics.
• Otherwise, they should be hospitalized for IV antibiotics.
• Fevers from pyelonephritis may take 24 to 48 hours to subside in the
setting of effective antibiotic therapy
• Incase of repeated Infections,nephrectomy is preferred

27. • Pyelonephritis can result in renal
scarring that is accelerated in
the setting of urinary
obstruction.
• Occasionally, pyelonephritis can
develop into an abscess that can
be located within the renal
parenchyma (renal abscess) or
between the capsule and
Gerota’s fascia

28. REFERRENCES
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781200/
• Schwartz’s Principles of Surgery Tenth Edition
• Bailey & Love's Short Practice of Surgery, 27th Edition