ETIOLOGY

Calcium stones
Idiopathic hypercalciuria
Hyperuricosuria
Primary hyperparathyroidism
Distal renal tubular acidosis (hereditary)
Intestinal hyperoxaluria
Hereditary hyperoxaluria
Hypercitraturia
Idiopathic stone disease

Uric acid stones

Gout
Idiopathic
Dehydration
Lesh nyhan syndrome (males)
Malignant tumors
Cystine stones
Cystinuria
Struvite stones
Infection

RISK FACTORS
Inadequate fluid intake
Climate
Excess intake of vitamin d & primary

hyperparathyroidism
Immobilization
Family history
Genetic influences
Diet (protein rich, calcium rich and low fluid
intake)

risk factors
Arthritis (painful joint inflammation)
Colitis (inflammation of the colon that causes

chronic diarrhea, dehydration, and chemical

imbalances)
Crohn's disease (intestinal disorder that
causes chronic diarrhea, dehydration, and low
citrate)
Gout (caused by excessive uric acid in the
blood)

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Hypertension (high blood pressure)
Hyperparathyroidism (excessive parathyroid

hormone, which causes calcium loss)

Medullary sponge kidney (congenital kidney
defect that may increase urinary calcium loss
and stone formation)
Renal tubular acidosis (inherited condition in
which the kidneys are unable to excrete acid)
Urinary tract infections (affect kidney
function)

TYPES OF STONES
Calcium oxalate stones:
Calcium phosphate stones
Struvite stones
Uric acid stones:
Cystine stones
Xanthine stones

SHAPE OF STONES

PATHOGENESIS
OF
SUPER SATURATION
STONES
equilibrium solubility product.
metastably super saturated
upper limit of metastability

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NUCLEATION:
Homogenous Nucleation
Heterogeneous Nucleation
INHIBITORS OF CRYSTAL FORMATION

RENAL COLIC
CLINICAL
URETERIC COLIC
MANIFESTATIONS
HEMATURIA
DYSURIA
NAUSEA
VOMITING
FEVER WITH CHILLS
S/S SHOCK

COMPLICATIONS
Decrease or loss of function in

the affected kidney

Kidney damage scarring
Obstruction of the ureter
Recurrence of stones
Urinary tract infection

INVESTIGATIONS:
Urine analysis: RBC in urine represents direct

trauma where as presence of WBC and

bacteria represent urinary stasis.
Urine culture: Reveals presence of infection.
Blood R/E: WBC is elevated with infection.
Increased serum levels of calcium, phosphate
and uric acid.
Intra Venous Pyelogram: Identify obstruction
in the urinary tract.

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CT scan: Identifies location and size of

obstruction.
Ultra Sonography.
Cystoscopy.
Blood urea Nitrogen and serum creatinine
levels are high.
A careful history including previous stone
formation, medication, family history of urinary
calculi.

MANAGEMENT
Pain management
Adequate hydration
Treatment and control of

infection
Drug therapy

Dietary restrictions
Purine rich foods: Sardines, meat soups,

liver, kidney, beef, pork, crab, sweet bread

Calcium rich foods: Milk, cheese, ice cream,

sauces containing milk, beans, fish with fine

bones, nuts, dried fruits, chocolate, and cocoa.
Oxalate rich foods: Spinach, asparagus,

cabbage, tomato, nuts, chocolate, celery,

cocoa, instant coffee

ESWL

SURGICAL MANAGEMENT
Indications for open surgical stone removal
include
Stones too large for spontaneous passage.
Stones associated with bacteriuria or
symptomatic infection
Stones causing impaired renal function
Stones causing persistent pain, nausea or ileus
Inability of patient to be treated medically
Patient with one kidney

ENDOUROLOGIC
PROCEDURES
Cystoscopy: If the stone is located in the bladder
Cystolitholapaxy: Large stones are broken up

with an instrument called lithrotrite. The bladder

is then irrigated and crushed stones are washed
out.
Cystoscopic Lithotripsy: Ultrasonic lithotrite is
used to pulverize the stone.
Flexible Ureteroscopes: Inserted via a cystoscope
can be used to remove stones from the renal
pelvis and upper urinary tract.

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PERCUTANEOUS NEPHROLITHOTOMY

(PCNL)

EXTRACORPOREAL SHOCK WAVE

LITHOTRIPSY (ESWL)

OPEN SURGICAL
APPROACHES
Nephrolithotomy
Pyelolithotomy
Ureterolithotomy
Cystotomy

NURSING DIAGNOSES
Pain during micturition rlt the presence of

stones and irritation.

Impaired urinary elimination pattern related to
the trauma or blockage of ureters, urethra
presence of stone as manifested by
hematuria.
Knowledge deficit about prevention of
recurrence, diet, symptoms of recurrence.

PREVENTION
MEASURES
Adequate hydration
Dietary restrictions of purines, oxalate and

protection when the patient is at risk of

developing stones.
Monitor the urinary PH and output daily.
Ambulate the patient.
Turn the patient every 2hrly
Regular intake of medicine to prevent stone
formation, eg: Allopurinol

RESEARCH STUDIES ON URINARY

STONES
Shock wave therapy for stones may increase the

risk of diabetes mellitus & hypertension. This may

be related such that shock wave therapy may
damage the pancreas during therapy that may
effect the islet cells in the pancreas that make
insulin. They believed the increased risk for
hypertension. May be related to scarring, with the
treatment may cause to the kidneys and could
alter the secretion of hormones centered in the
kidneys like renin, with influence BP.
(In a urology article 2006, shock wave therapy for
kidney stones linked to DM, HTN, A study
conducted by Rochester, Minn mayo clinic
researhc.)

Findings indicate that higher intake of

dietary ca decreases the risk of kidney
stone formation in younger women.
Phytate found in plants & cereals also
inhibit the formation of kidney stones.
(Dietary ca associated with reduced
risk of kidney stones in younger
women, science daily, 2004.)

There have been many studies on the role of

nutrition in helping to reduce kidney

stones.This study conducted on more than
90,000 women, showed that women with the
highest intake of dietary calcium had the
lowest risk of kidney stones. Calcium is
believed to neutralize the absorption of
oxalate which has been linked to kidney
stones.
It has been suggested that people who form
kidney stones should avoid vitamin c
supplements, because vitamin c can convert
into oxalate and increase urinary oxalate.

In a double-blind trial, supplementation

with 200 IU of synthetic vitamin E per day was
found to reduce several risk factors for kidney
stone formation in people with elevated levels
of urinary oxalate.