The document discusses renal calculi (kidney stones). It outlines factors in the environment that can contribute to kidney stone formation, including physical activity, work environment, nutrition, body mass, gender, ethnicity, and geographic location. It describes the normal functions of the kidneys and how alterations in physiological mechanisms can lead to renal calculus. Common types of stones are discussed along with their contributing factors and treatment options. Pharmacological treatments include thiazide diuretics, allopurinol, and sodium bicarbonate. Nursing considerations for patients taking these medications focus on monitoring for side effects and complications.

1. Zarish Fazil
Post Rn BSN Student
RENAL CALCULUS

2. RENAL CALCULUS

3. OBJECTIVES
At the end of this presentation students will be able to.
• Explain the factors in environment, which contribute to produce
changes in physiological process of the body.
• Discuss the relationship of normal body function with altered
physiological mechanism in disease process.
• Integrate the knowledge of basic principles of pathophysiology
and pharmacology with the disease process.

4. THE KIDNEYS FUNCTIONS
• The main purpose of the kidney is to separate urea, minerals,
salts, toxins, and other waste products from the blood.
• They also do the job of conserving water, salts, and electrolytes.
• At least one kidney must function properly for life to be
maintained.

5. FACTORS IN ENVIRONMENT
• Physical activity
• The more active you are, the more you are likely to
perspire.
• While exercise is an excellent way to maintain or reach
your goal body weight, improve cardiovascular function
and increase muscle and bone mass, it may also lead
to dehydration and overly concentrated urine if you do
not replace fluids. The more you sweat, the more fluids
you should drink.

6. FACTORS IN ENVIRONMENT
PHYSICAL ACTIVITY CONTINUE………….
• If you are very inactive, you may be losing bone
strength, which could result in loss of calcium from
bone. That calcium is filtered by the kidneys and a
large amount of calcium may not be able to be
reabsorbed. Instead, excessive calcium gets excreted
in the urine, where it can lead to stone formation.

7. FACTORS IN ENVIRONMENT
• Work environment
• If you work in high temperatures, such as in hot
weather or in certain types of manufacturing or
processing where high temperatures are the norm, you
may be predisposed to dehydration and concentrated
urine.
• Restricted fluid intake will cause your urine to be
concentrated and increase the chance of forming
kidney stones.

8. FACTORS IN ENVIRONMENT
• Nutrition
• Lack of fluids
• Too much sodium
• Too much meat from beef, poultry, fish, and seafood
• Too little or too much calcium
• Too much oxalate absorbed
• Too few fruits and vegetables

9. FACTORS IN ENVIRONMENT
Body mass
• Body weight is an increased risk for kidney stones,
especially for women.
• Waist circumference is also associated with increased
risk for stones. The larger your waist size, the more
likely you are to form stones.

10. FACTORS IN ENVIRONMENT
• Gender
• Men generally have a higher incidence of stone formation.
• An increase in stone formation among women has been observed
over the last couple of decades. Pregnancy increases the risk for
stone formation among women, but the incidence is quite low (one
in 1,500 pregnancies).
• Age
• The risk of stone formation appears to increase with age up to
about 50 years. The majority of kidney stones occur in people
between 20 and 60 years of age. At about 60 years, the overall
incidence of kidney stones slowly declines with age.
.

11. FACTORS IN ENVIRONMENT
• Ethnicity
• Among Americans, Caucasians have the highest incidence of
kidney stones, followed by Mexican-Americans. African-
Americans have the lowest risk.
• Geographic location
• the hotter weather may lead to dehydration, which may cause
urine to become too concentrated

12. RELATIONSHIP OF NORMAL BODY FUNCTION WITH
ALTERED PHYSIOLOGICAL MECHANISM IN RENAL
CALCULUS
• The term renal calculi and nephrolithiasis refers to kidney
stones.
• The most common cause of upper urinary tract obstruction is
urinary calculi.
• Stones can form in any part of urinary tract, most develop in
kidneys.
• Urinary stones are third most common disorder of urinary tract
after UTI’s and prostate disorders.
• Men are two to three times likely to develop calculus than
women.

13. • Kidney stones are
crystalline structures made
up of the material that the
kidneys normally excrete in
the urine.
• Stones require a nidus to
form and urinary
environment that supports
continued crystallization of
stone components.
• Calcium (oxalate and
phosphate), magnesium,
ammonium phosphate, uric
acid and cysteine.
• The matrix theory proposes
that organic materials such
as epithelial cells that lines
the tubules
(mucopolysaccrides) act as
nidus.
PATHOPHYSIOLOGY

14. • The development of stone
component is influenced by
the concentration of stone
components in the urine,
the ability of the stone
components to complex
and form stone, and the
ability of substances that
inhibit stone formation
• Proteins produced by kidney
inhibit all phases of
crystallization.
• The persons who have
deficiency of inhibiter protein
are at risk of calculus.
• Kidney cells produce at least
three proteins that are thought
to slow down the calcium
oxalate crystallization (nephro
calcine, mucoprotein, and
uroprotein.
PATHOPHYSIOLOGY CONTINUE

15. • Nephrocalcine
• Tamm Horsfall mucoprotein
• Uroprotein
• Nucleation, aggregation,
and growth of calcium
oxalate stone.
• Exerts a minor effect on
crystal aggregation.
• Uroprotein inhibits the
growth of calcium oxalate
crystals.
KIDNEY’S PROTEINS
ORGANIC INHIBITORS

16. NON ORGANIC INHIBITORS
• Some non organic substances also can act as inhibitors of stone
formation. For example, citrate is a key factor affecting
development of calcium stones.

17. TYPES OF STONES
• There are four basic types of kidney stones
• Oxalate and phosphate
• Magnesium ammonium phosphate( struvite)
• Uric acid (urate)
• Cystine

18. CLINICAL MANIFESTATIONS
• Renal colic due to obstruction and distention.
• Flank pain
• Hematuria
• Pyuria

19. • Caused by stone that produce
distension of renal calices or
renal pelvis.
• Usually dull pain, deep ache in
flanks or back.
• Can be mild to sever.
• Often exaggerates by drinking
large amount of fluid
• Describes the colicky pain
accompanies stretching of the
collecting system or ureters
• Excruciating pain in flank and
upper outer quadrant of the
abdomen on affected side.
• 1-5 mm in diameter that can
move into the ureter and obstruct
the flow.
• Skin may be cool and clammy.
• Nausea and vomiting are
common
MANIFESTATIONS
PAIN OF TWO TYPES DEPENDING ON LOCATION
Renal colic Noncolicky renal pain

20. DIAGNOSIS
• Diagnosis of kidney stones is best accomplished using an
ultrasound, intravenous pyelography (IVP), or a CT
scan. Other tests include:
• Urinalysis
• blood tests for calcium, phosphorus, uric acid, and
electrolytes. blood urea nitrogen (BUN) and creatinine to
assess kidney functioning.
•
Most kidney stones will pass through the ureter to the bladder
on their own with time. Treatment includes pain-control
medications and, in some cases, medications to facilitate the
passage of urine.

21. Type of stone Contributing Factors Treatment
Calcium (oxalate and
phosphate)
Hypercalcemia and hyper
calciuria Immobilization
Hyperparathiroidism
Vitamin D intoxication, defused
bone disease, Renal tubular
acidosis Hyperoxaluria
Treatment of underlying
conditions increased fluid intake
Thiazide diuretics
Dietary restriction of foods high
in oxalate
Magnesium ammonium
phosphate (struvite)
Urinary tract infection Treatment of UTI
Acidification of urine
Increased fluid intake
Uric Acid Formed in acid urine with pH of
approximately 5.5
Gout
High purine diet
Increased fluid intake
Allopurinol for hyperuricuria
Alkalinazation of urine
Cystine Cystineuria (inherited disorder
of amino acid metabolism
Alkalinazation of urine
Increased fluid intake

22. PHARMACOLOGY
• Treatment of underlying conditions.
• Thiazide diuretics
• Allopurinol for hyperuricuria
• Alkalinization of urine by administration of intravenous sodium
bicarbonate to produce urine with a pH ≥7.5. (normal urine PH
is 6.0)
• One treatment option is lithotripsy. This treatment uses shock
waves to break up the kidney stones into small pieces. After
the treatment, the small pieces of the kidney stone will pass
through your urinary tract and out of your body with your urine.

23. ALLOPURINOL
• Brand Name: Aloprim, Apo-Allopurinol (CAN), Purinol (CAN),
Zyloprim
• Classification: Antigout drug
• Vomiting
• Diarrhea
• Drowsiness
• Headache
• Muscle pain
• Changes in sense or taste

24. THIAZIDE DIURETICS
• dizziness and lightheadedness,
• blurred vision,
• loss of appetite,
• itching,
• stomach upset,
• headache, and.
• weakness.

25. BICARBONATE
• Frequent urge to urinate, headache (continuing), loss of appetite
(continuing),mood or mental changes, muscle pain or twitching,
nausea or vomiting, nervousness or restlessness. slow breathing.
Respiratory drive may be suppressed after bicarbonate administration
due to increased venous C02 concentration.
• Without adequate ventilation, worsened systemic acidosis could
develop Rare cases of sodium bicarbonate abuse have been
associated with features of Munchausen syndrome
• Metabolic side effects have included metabolic alkalosis.
• Hypernatremia and hypokalemia

26. PHARMACOLOGICAL NURSING IMPLICATIONS
• Encourage fluid intake to also help with excretion, as well as
reduce kidney stone formation.
• Monitor for joint pain and swelling and educate the patient
regarding taking additional pain medication when experiencing
acute gout flare-ups. This can happen frequently in the first few
months of allopurinol therapy.

27. NURSING CONSIDERATIONS
• Assess the client’s fluid balance throughout the therapy. Including intake and
output, daily weight, edema and lung sounds.
• Monitor the client’s serum calcium, sodium, potassium, bicarbonate
concentrations, acid-base balance and renal function throughout the therapy.
• Symptoms of fluid overload should be reported such as hypertension,
edema, difficulty breathing or dyspnea, crackles and frothy sputum.
• Sigs of acidosis should be assessed such as disorientation, headache,
weakness, dyspnea and hyperventilation.
• Assess for alkalosis by monitoring the client for confusion, irritability,
paresthesia, tetany and altered breathing pattern.
• Hypernatremia clinical manifestations should be assessed and monitored
which includes: edema, weight gain, hypertension, tachycardia, fever,
flushed skin and mental irritability.

28. NURSING CONSIDERATIONS
• Hypokalemia should also be assessed by monitoring signs and symptoms
such as: weakness, fatigue, U wave on ECG, arrhythmias, polyuria and
polydipsia.
• IV sites should be observed closely. Extravasation should be avoided as
tissue irritation or cellulitis may occur when taking sodium bicarbonate.
• If infiltration occurs, the physician should be notified immediately. Confer with
the doctor or other health care staff regarding warm compresses and
infiltration site with lidocaine or hyaluronidase.
• Tablets must be taken with a full glass of water.
• For clients taking the medication as a treatment for peptic ulcers it may be
administered 1 and 3 hours after meals and at bedtime

29. REFRENCES
• Concepts of altered health states
seventh edition by Carol Matison
• Research report:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826902/