renal calculus - bangalore group of institutionrenal calculus mrs. preethi ramesh senior nursing...

RENAL CALCULUSMrs. Preethi Ramesh

Senior Nursing Lecturer

BGI

INTRODUCTION

Urolithiasis refers to stones (calculi) in the urinary tract &

Nephrolithiasis refers to the stones in the kidney.

Stones are formed in the urinary tract when urinary concentrations of

substances such as calcium oxalate, calcium phosphate, and uric acid

increase.

This is referred to as supersaturation and is dependent on the amount

of the substance, ionic strength, and pH of the urine.

DEFINITION

INCIDENCE

The occurrence of urinary stones occurs predominantly in the third to fifth decades of life and affects men more than women.

About half of patients with a single renal stone have another episode within 5 years.

Stone occurs more often in summer season.

Most stones contain calcium or magnesium in combination with phosphorus or oxalate.

Most stones are radiopaque and can be detected by x-ray studies.

India-each year 5-7 million cases are diagnosed.

1/1000 need hospitalization.

TYPES OF STONE

ETIOLOGY & RISK FACTORS

ETIOLOGY & RISK FACTORS

Chronic dehydration, poor fluid intake, and

immobility

Living in mountainous, desert, or tropical areas

Infection, urinary stasis, and periods of

immobility

Inflammatory bowel disease and in patients

with an ileostomy or bowel resection because

these patients absorb more oxalate.

Medications- antacids, acetazolamide (Diamox),

vitamin D, laxatives, and high doses of aspirin

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

Many theories have been proposed to explain the formation of stones in the urinary tract. No single theory can account for stone formation in all cases.

Crystallization appears to be the primary factor in calculus development from:

1. Supersaturation of urine with increased solutes

2. Matrix formation caused when mucoproteins bind to the mass of the stone

3. Lack of inhibitors caused by increased or absent protectors against stone

formation

4. A combination of these conditions

Location of stones

Kidney

Ureter

Bladder

Urethra

RENAL CALCULUS

SITES OF OBSTRUCTION

CLINICAL MANIFESTATION


1. Pain

2. Heamturia

3. Dysuria

4. Oedema

5. Pyuria

Associated symptoms:

1. Nausea, vomiting, diarrhea, abdominal discomfort

2. Chills and fever (may)


1. Pain

Stones in the renal pelvis may be associated with an intense, deep ache in the costovertebral region

Pain originating in the renal area radiates anteriorly and downward toward the bladder in the female and toward the testis in the male.

If the pain suddenly becomes acute, with tenderness over the costovertebral area, and nausea and vomiting appear termed as renal colic

Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia. It is called ureteral colic

Colic is mediated by prostaglandin E, a substance that increases ureteral contractility and renal blood flow and that leads to increased intraureteral pressure and pain

If the stone present in the bladder and obstruct he urine flow, produces the pain at suprapubic region along with bladder distension


2. Hematuria

Hematuria is often present because of the abrasive action of the stone.

3. Dysuria

Painful micturition is termed as dysuria.

Obstruction in urine flow tend to cause the dysuria.

4. Oedema

When the stones block the flow of urine, obstruction develops, producing an increase in hydrostatic pressure and distending the renal pelvis and proximal ureter. Thereby GFR decreases leads to sodium and water retetion and gives rise to oedema.


5. Pyuria

Obstruction in urine flow, urinary retention and urinary stasis may cause the UTI and featured as pyuria.

Associated symptoms-

1. Nausea, vomiting, diarrhea, abdominal discomfort due to renointestinal reflexes and shared nerve supply (celiac ganglion) between the ureters and intestine. and the anatomic proximity of the kidneys to the stomach, pancreas, and large intestine.

2. Features of infection-

Due to UTI.

These features may be chill, high grade fever dysuria etc.

DIAGNOSTIC EVALUATION

Diagnostic evaluation

History

Physical examination

Urinanalysis

Blood studies

Stone chemistry

Radiographic studies


History

• Diet

• Water

• Occupation

• Medication

• Past and recent medical history

• Collect the informations regarding the reasons for seeking health care

services


Physical examination

Locate, nature and characteristics of pain

Assess the level of pain, tenderness etc.

Observe for the associated symptoms.


Urinanalysis

• Hematuria and pyuria

• pH < 5.5 indicates uric acid stone

• pH > 7.5 indicates struvite stone

• Urine culture and drug sensitivity studies to

detect infection.

• 24-hour urine test for measurement of calcium,

uric acid, creatinine, sodium,citrate and oxalate


Blood studies

• Hyperuracemia

• Hypercalcemia

• Neutrophilia

• Elevated serum parathyroid hormone


Stone chemistry

• Collection of stone through a strainer is useful.

• Analyze the stone chemically to find out the composition which helps in

therapeutic management.


Radiographic studies

• Kidney, ureters, and bladder

radiography may show stone.

• Intra venous urogram (intravenous

pyelogram) to determine site and

evaluate degree of obstruction

• Retrograde pyelography

• Ultrasound

• Helical or axial CAT Scan

CONTINUES…

STAY BLESSED

renal calculus - bangalore group of institutionrenal calculus mrs. preethi ramesh senior nursing...

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