UROLITHIASIS

RENAL CALCULI
 UROLITHIASIS
REFERS TO CALCIFICATIONS
OR PRESENCE OF STONES IN
THE URINARY SYSTEM.
NEPHROLITHIASIS- CALCULI
IN THE KIDNEY
 ETIOLOGY
• Men between 30 and 50 years old
• Immobility and sedentary lifestyle which increase
stasis.
• Dehydration, which leads to super saturation
• Metabolic isturbances resulting to increase calcium
and ions in the urine.
• History of Urinary Calculi
• Diet in high in Purine, Oxalates, Calcium
• UTI
• Prolonged indwelling catheterization
 TYPES OF STONES
• Calcium Stones
– Is the most common substances and is found in up to 90%
of stones.
– Are usually composed of calcium phosphate or calcium
oxalate.
– It caused by four main function:
• A high rate of bone reabsorption.
• Gut absorption of abnormally large amounts of calcium,
as in milk-alkali syndrome, sarcoidosis, and excessive
intake of vitamin D
• Impaired renal tubular absorption of filtered calcium
• Structural abnormalities, such as “sponge kidney”
• Oxalate Stones
– Second most frequent stone is oxalate, which is relatively
insoluble in urine.
– Its solubility is affected only slightly by changes in pH
– Oxalate stones may be related to the following:
• Hyperabsorption of oxalate
• Postileal resection or small bowel bypass surgery
• Overdose of ascorbic acid (vitamin C)
• Familial oxaluria
• Concurrent of fat malabsorption
• Struvite Stones
– Also called “triple phosphate”
– Composed of carbonate apatite and magnesium
ammonium phosphate
– It cause by a certain bacteria, usually Proteus, which
contain enzyme ureas. This enzyme splits urea into two
components ammonia molecule, which increase the
urine pH (usually Alkaline). This ph is prone from
bacteria.
– This stones formed in the manner are “STAGHORN
CALCULI”
Anatomy
• Kidney, paired organ whose functions include
removing waste products from the blood and
regulating the amount of fluid in the body. The
basic units of the kidneys are microscopically thin
structures called nephrons, which filter the blood
and cause wastes to be removed in the form of
urine. Together with the bladder, two ureters, and
the single urethra, the kidneys make up the body’s
urinary system. Human beings, as well as
members of all other vertebrate species, typically
have
• A primary function of kidneys is the removal of
poisonous wastes from the blood. Chief among
these wastes are the nitrogen-containing
compounds urea and uric acid, which result from
the breakdown of proteins and nucleic acids.
Life-threatening illnesses occur when too many
of these waste products accumulate in the
bloodstream. Fortunately, a healthy kidney can
easily rid the body of these substances.
• In addition to cleaning the blood, the kidneys perform
several other essential functions. One such activity is
regulation of the amount of water contained in the
blood. This process is influenced by antidiuretic
hormone (ADH), also called vasopressin, which is
produced in the hypothalamus (a part of the brain that
regulates many internal functions) and stored in the
nearby pituitary gland. Receptors in the brain monitor
the blood’s water concentration. When the amount of
salt and other substances in the blood becomes too high,
the pituitary gland releases ADH into the bloodstream.
When it enters the kidney, ADH makes the walls of the
renal tubules and collecting ducts more permeable to
water, so that more water is reabsorbed into the
bloodstream.
 PATHOPHYSIOLOGY
• Crystals are formed from super saturated
urine with increase solutes.
• Mucos and protiens bind to the mass of stone
forming matrix with lack of stone inhibtors.
(citrate, Mg, pyrophospahate)
• Growth continues by aggregations to form
larger particles travel down from urinary
tract.
• Trapped and become site for stone formation
 FORMATION OF STRUVITE
STONES
Urea splitting bacteria
Hydrolysis
Ammonia
Hydrolysis Struvite stones
Ammonium hydroxide
Increase pH(alkaline)
Increase amunt of deprotonated phosphate
 – Struvite stones is difficult to eliminate because of hard
stone forms around a nucleus of the bacteria, which
protecting the bacteria from antibiotic theraphy
– Any small fragment left after surgical removal of the
stones begins the cycle again
• Uric Acid
– Are caused by increased urate excretion fluid depletion,
and low urinary pH
• Cystinuria
– Is the result of a congenital metabolic error as an
autosomal recessive disorder
• Xanthine
– Stones occur as a result of rare hereditary condition in
which there is a xanthine
 SIGNS AND SYMPTOMS
• Sharp excruciating severe pain of sudden onset
radiating from flank into the groin.
• Nausea and vomiting reflex action to pain
• Restlessness, diaphoresis, rapid pulse
• Oliguria- obstruction made by stones
• Hematuria- due to abrasive action of stone as it
moves doewn
 Nursing Management
Fluids (3000 ml/day) unless contraindicated
• Strain all urine for passage of stone(80-90 of stones pass out spontaneously)
• Adjust urine ph
• Ca stones
• Limit dairy products
• Acid ash diet ( cranberry/prune juice, meat, eggs, fish, poultry, grapes, whole grain
citrus fruits,
• Vit. C
• Oxalate stones
• Avoid excess tea, chocolates, spinach
• Acidic stones
• Alkalinize urine
– Na Bicarbonate tablets
– Alkaline - ash diet ( milk, vegetables, fruits, salmon)
•
• Uric Acid stones
– Avoid purine foods
• Organ meat
• Shellfish
• Meat groups
• Gravy
• Legumes
• Salted anchovies
• Mushrooms
• Sardines
• ● Encourage ambulation
• ● MIO – notify doctor for anuria or hematuria
• ● Medication
• Pain control ( Demerol)narcotic analgesic
• Allopurinol (to ↓ uric acid)
• ● Surgery ( Nephrolithotomy, pyelolithotomy, uterolithotomy,
litholapaxy)
• ● ESWL ( extracorporeal shock wave lithotripsy) crushing of stone
with the use of
ultrasonic waves while the body is half immersed in water.
 Medical- Surgical Interventions
• Endorologic Proceduures
• 1.Small stones removed trans urethrally with a cystoscope, ureteroscope,
ureteroremoscope.
• 2.Lithitrite- stone crusher instrument to facilitate removal of stone.
• 3. Lithotripsy
• A. Laser Lithotripsy- lasers are used together with a ureterooscope to
remove or loosen impacted stones.
• B. Extracorporeal Shockwave Lithotripsy- disintigration of stone by use
of laser release into the water producing shockwave.
• - place in special tank of water.
• 4. Open Surgical Procedures
• A. Ureterolithotomy- surgical removal of stones from the ureter through
flank incision for higher stones or abdominal incision for lower ones.
Penrose drain is placed post op.
• B. Cystolithotomy- removal of bladder calculi through a supra pubic
incision.
 POSSIBLE NURSING
DIAGNOSIS
• Acute pain related to irritation and spasm
from stone movement in the urinary tract
• Risk for injury related to post operative
complication
• Effective therapeutic regimen management
related to prevention of calculi
•
 Presented to:
Mrs.Rosadel Faceronda

Evangelio, Lalaaine
Gallofin, Arva Glazel
Gialolo, Jennife
Jubilan, Virgie Lyn
Labang, Kristine Ann
Labrador, Josie Lou
Galaura, John May Emmanuel
Gallego, Mikhail