Stones

 Urine is a combination of water (sebagai pelarut), particle, and solutes

 Solutes overconcentrated  supersaturated
 Superaturation of certain solute leads to precipitation/crystalization
 Crystal yang terbentuk akan menjadi nidus (tempat buat mengendapnya zat-zat lain dan
membentuk crystal)
 Supersaturation of solute bisa terjadi pas increase of solute atau decrease of solvent
(dehydration)
 Dehydration low urine volume  increase chance of kidney stone
 Jenis-jenis batu
 Calcium  80%
Calcium Oxalate (positively charged calcium bind to negatively charged oxalate) 
black/dark brown envelope or dumbbell-liked stones
- Radioopaque (X-ray/CT)
- RF
i. idiopathic
ii. hypercalciuria
iii. hypercalcemia
iv. hypocitrat (citrate prevents stone formation by inhibiting crystal growth and
aggregation)
v. Fat Malabsoprtion (Crohn’s Disease/gastric bypass operation)
Fat ga diserap  bind to calcium  leave oxalate to be absorbed by intestine 
oxalate level di darah naik
vi. Ethylene Glycol/antifreeze (forms oxalate once ingested)
vii. Vitamin C abuse (product of vitamin c metabolism is oxalate)
- Treatment: Thiazide, potassium citrate (binds calcium di urine, preventing reabsorption),
low-sodium diet (less sodium reabsorb, less calcium reabsorb  hypercalciuri)
Calcium Phosphate Stone (calcium bind to negatively charged phosphate)
- Dirty white color, radiopaque
- RF: renal tubular acidosis
 Struvite  15% (infection stone-mixed of magnesium, ammonium, phosphate)
- Forms pas ada Proteus mirabilis, Staphylococcus saprophyticus, Klebsiella sp
- Microorganism ini pakai enzyme urease untuk memecah ammonia dan CO2
- Ammonia buat urine menjadi lebih base dan memicu pengendapan dari magnesium,
ammonium, dan phosphate
- Often branch into the several calyces kyk tanduk rusa
- Radiopaque X-ray, less dense than calcium stones
- Biasa di renal calculi
- Treatment: antibiotic, surgery
 Uric acid  5% (monosodium urate)
- Red-brown in color, rhomboid/rosettes in shape
- Radiolucent, minimal sight di CT
- RF: dehydration, hyperuricemia (gout), cancer treatment
 - Treatment: alopurinol  decrease uric acid
 Cysteine Stone (rare-amino acid cystein)
- Yellow/light pink hexagonal stone
- Crsytalize more when acid
- X-ray  faintly radiolucent
- CT Scan  moderately radiopaque
- RF: cystinuria (autosomal recessive  decrease reabsorption of amino acids di proximal
convoluted tubule)
- Test cystein di urine  sodium cyanide nitroprusside

Neurogenic Bladder  impaired control of bladder emptying due to nerve damage

- Bladder fills damaged s2 s3  impaired signal transmission, lack of voluntary control 

incontinence
i. Overflow incontinence (bladder penuh, release urine involuntary all at once  hasil dari
impaired capacity to detect bladder filling)  DM, Syphilis, Herpesvirus, spinal injury
ii. Urge incontinence (small amount of urine initiates micturition reflex involuntarily 
hasil dari impaired capacity to inhibit micturition reflex)  multiple sclerosis (damage di
s2 s3 myelin sheath), spinal shock, stroke, parkinson, brain tumor