Kidney stones

2. ⦿Over view
⦿Symptoms
⦿Risk factors
⦿Types of stones
⦿Treatments
⦿Urinary tract infections

3. ⦿ Large stone ( > 5 millimeters ) can cause
blockage of the ureter resulting in severe
lower back pain or abdominal pain .
⦿ Most stones form due to acombination of
genetics and environmental factor .
⦿80 % of stones are calciumoxalate .
⦿If stonescauses nosymptoms : no
treatment is needed .

4. ⦿ Nephrolithiasis :in the kidney .
⦿ ureterolithiasis :in the ureter .
⦿ Cystolithiasis :in the bladder .

5. ⦿Depends on stone location & size
1 acute renal colic ( one of the strongest
pain sensation )
Sudden onset of severe pain , at least
50% of patients will also have nausea
and vomiting
2 hematuria
3 urinary frequency , urgency , dysuria ,
stranguria .
4 fever and chills because of infection .

6. ⦿Risk factors
 Low fluid intake :major factor in stone
formation
 Dietary :get enough dietary calcium
Limit from animal protein , sodium and
oxalate.
⦿Diagnosis
 Urine analysis
 Urine culture
 Serum uric acid and calcium level
 X-rays

7. ⦿ Classification of kidney stone
Type Prevalance Circumstances
Calcium oxalate 80% Acidic urine
Type Prevalance Circumstances
Acidic urine
Calcium oxalate 80%
Calcium phosphate 5-10% Alkaline urine
Uric acid 5-10% Acidic urine
Struvite
((magnesiu
m
ammonium
phosphate ))
10-15% Infections in the
kidney
(( ammonia
producing bacteria
))

8. ⦿ Life style modifications
- Adequate fluid intake (2.5-3 L )
- Moderate dietary calcium intake
- Avoid oxalate containing foods ( spinach ,
bran , potato chip , frech fries , nut , beets .
- Limit animal protein
- Limit sodium intake .

9. o Drug therapy
1 -Thiazide diuretics

10. 2- Alkalinizing agents
Citrate treatment
Epimag :category B

11. ⦿Citrate treatment raise urine PH and this
may increase the risk for calcium
phosphate stonesif urine calcium
remains high and fluid intake isn’t
maintained .

12. ⦿Category C

13. ⦿ Life style modification
- Adequate fluid intake
- Moderate dietary calcium intake
- Limit animal protein & sodium intake

14. ⦿Drug therapy
1 thiazode diuretics
2 acidifying urine

15. ⦿ Life style modifications
- Fluids
- Limit purine rich foods

16. ⦿Alkalinizing agent
Potassiumsodium hydrogen citrate
Category D
Contraindicated in chronic urinary tract
infections

17. ⦿Piperazine citrate :increase the solubility
of urates .
⦿Colchicine :for acute gout attack
⦿Atropine :relieves spasms of the urinary
tract
Contraindicated in pregnancy

18. ⦿ Halphabarol ( halfa bar )
Antispasmodic and used widely in
management of renal colic

19. ⦿ Khellin
Decrease calcium oxalate stone formation
Anti bacterial activity , antispasmodic and
acting as a diuretic .

20. Decrease stone formation
Anti bacterial activity , antispasmodic and
acting as a diuretic .

21. ⦿Urinary muscle relaxant , facilitating
ureteral stone passage and decrease
calcium oxalate stone formation .

22. ⦿Culture result
Most common
Sulfamethoxazole / trimethoprime

23. ⦿ Nitrofurantoin

24. ⦿ Pain management
Diclofenac isthe first choice for renal colic
One amp and can be repeated once 30 min.
later if required

25. ⦿ Antiemetic therapy
10 mg every 4 - 6 hrsas needed

26. ⦿Antispasmodic therapy
Hyoscine N-butylbromide
Facilitate ureteral stone passage by acting
as a muscle relaxant

27. ⦿ Drotaverine

28. ⦿ - blockers
Selective 1A receptorantagonist
Relax smooth muscle

29. ⦿Phosphodiesterase 5 inhibitors
Relaxing effects of ureteral