THE PATIENTS ILLNESS (Nephrolithiasis) Pathophysiology (Book-based)
Non-modifiable Factors  Age (over 20 to 40 years old)  Sex (Male>Female 4:1 )  Family history, Hereditary  Race (Mostly Caucasian), influence with lifestyle, diet  Seasonal factors  Urinary tract malformation  Hyperparathyroidism  Diabetes Melitus
Modifiable Factors        

Faulty Diet Metabolic disorders, obesity Excessive medications (ceftriaxone) Low fluid intake and excessive intake of protein, salt and oxalate Nature of work (occupation) Stimulation of Calcium precursor Weight Loss Hypertension

Super saturation of one or more salts in the urine

Precipitation of the salts from a liquid to a solid state

Growth through crystallization or agglomeration (aggregation)

Super saturation of salt in the urine


PH Alkaline urine increases risk of forming calcium stones due to excessive calcium Acidic urine increases risk of forming uric acid stones due to increase in acidic food intake Xanthine readily precipitates with acidic urine but Ph does not directly affect the formation of this type of stone

Salt forms crystals which can grow into stones in the presence of super saturated urine

Multiple salts may precipitate into crystals

Formation of Nidus (nucleus) of a urinary calculus.

Intermittent supersaturation due to ingestion of a meal or during dehydration may also contribute

Renal tubules and papillae have surfaces which attract crystalline nidus and add biological material forming stones
Crystal growth inhibting substances

3 Endogenous factors:

Particle Retention


Pyrophosphate, Potassium citrate, Magnesium

Antegrade urine flow, urinary stasis, anatomic abnormalities

Organic matrix

Pomote growth of infection calculi Impairment in natural flushing of crystals

Retention of stone foramtion

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