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 bodys
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 nitrogencontaining 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 bloods 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
Ammonium hydroxide
Increase pH(alkaline)
Increase amunt of deprotonated phosphate

Struvite stones

 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