INDEX

S.NO CONTENT PAGE NUMBER

1. INTRODUCTION

2. HISTORY AND
PHYSICAL STATE OF
THE PATIENT
3. DIAGNOSIS FOR
KIDNEY STONE

4. CASE STUDY ON
THE AFFECTED
PERSON

5 MANAGEMENT AND
TREATMENT

6. PREVENTION
 INTRODUCTION

What are uric acid stones?

Uric acid stones are one of four types of kidney stones. A kidney stone is a
collection of minerals and salt that hardens. Kidney stones form in the
kidneys or urinary tract, the path that urine takes to leave the body. They
can cause pain and blood in the urine, but treatment can help.

Other types of kidney stones include:

 Calcium stones.
 Struvite stones.
 Cystine stones.

What is uric acid?

Uric acid is a waste product that’s in your blood. Your body produces uric
acid when it breaks down chemicals called purines. Most uric acid
dissolves in your blood and passes through the kidneys. It leaves your body
in your urine.

How do uric acid stones form?

If you have high levels of uric acid, then crystals start to form. These uric
acid crystals combine with other substances in your body and create a
solid mass. The mass keeps growing. It may stay in the kidney or move
down the urinary tract and settle in the ureter.

If the stones are very small, they may pass out of your body in your urine
without too much pain. But if they don’t pass, they cause urine to back up
in the kidney, ureter, bladder or urethra. That’s when you get pain and
other symptoms.
Who’s at risk of getting uric acid stones?

If you don’t drink enough water, you have a higher chance of developing
uric acid stones and other kidney stones. Other risk factors include:

 Chemotherapy
 Conditions such as obesity and Type 2 diabetes.
 Diet high in salt and sugar.
 Family history of kidney stones.
 Too much or too little exercise.
 Weight loss surgery.
 Taking certain medications, such as diuretics and immune
suppressants.

How common are uric acid stones?

Researchers estimate that one in 10 people in the United States will have a
kidney stone at some point in their lives. They’re more common in men
than women. For men, the lifetime risk is about 19%. For women, it’s
about 9%.

Most people don’t get kidney stones before age 30. But many cases can
happen earlier in life, even among children.

What is high uric acid level?

Uric acid is a waste product found in blood. It’s created when the body
breaks down chemicals called purines. Most uric acid dissolves in the
blood, passes through the kidneys and leaves the body in urine. Food and
drinks high in purines also increase the level of uric acid. These include:

 Seafood (especially salmon, shrimp, lobster and sardines).

 Red meat.
 Organ meats like liver.
 Food and drinks with high fructose corn syrup, and alcohol
(especially beer, including non-alcohol beer).
If too much uric acid stays in the body, a condition called hyperuricemia
will occur. Hyperuricemia can cause crystals of uric acid (or urate) to
form. These crystals can settle in the joints and cause gout, a form of
arthritis that can be very painful. They can also settle in the kidneys and
form kidney stones.

If untreated, high uric acid levels may eventually lead to permanent bone,
joint and tissue damage, kidney disease and heart disease. Research has
also shown a link between high uric acid levels and type 2  diabetes, high
blood pressure, and fatty liver disease.

Nephrolithiasis is a frequent health problem in developed nations with a

worldwide estimated 2 to 5% of people affected at least once in their
lifetimes. In the United States, the overall lifetime risk for urinary stones in
men is 10.6%, and for women, 7.6%. The majority of untreated patients
suffer from periodic abdominal pain, urinary tract infections, and loss of
kidney function; eventually leading to renal failure. Numerous conditions
increase susceptibility to the nephrolithiasis, which includes genetic
disorders, dietary and environmental factors. [3][4][5][6] Besides uric
acid stone disease, elevated serum uric acid levels are also a risk factor for
gout as well as cardiovascular disease, diabetes and chronic renal
failure. [7][8]
Uric acid calculi make up 10 to 15% of all urinary tract stones with the
overwhelming majority, 79%, presenting in men, most frequently in the
60 to 65 year old age group. [9] Obesity, hyperglycemia (elevated blood
sugar), metabolic syndrome and high blood pressure are frequently
associated with uric acid calculi in Western countries.
The occurrence of uric acid stones has risen considerably in patients
suffering from metabolic syndrome. Uric acid stones are commonly seen in
patients with hyperuricosuria, but overall, aciduria is the most common
underlying etiology. The cause of aciduria is thought to be due to diet-
dependent as well as diet-independent causes such as metabolic syndrome,
which tends to produce a net acid load. Another underlying factor is
reduced hepatic ammonia synthesis. This causes an increase in net acid
excretion as there is less ammonia buffering of excess acid.
Gout and/or hyperuricemia is associated with uric acid uropathy in 15 to
25% of uric acid nephrolithiasis patients.  A purine-rich diet, including
substantial animal protein, further increases the risk of uric acid
nephrolithiasis.
Uric acid is much less soluble at a low urinary pH (5.5 or less), whereas
solubility greatly increases at a higher urinary pH (especially at pH of 6.5
or more).  Diurnal variations also play a role as the lowest urine
production and lowest urinary pH both occur in the early morning so this
is when uric acid crystals are most likely to form
HISTORY AND PHYSICAL STATE OF THE PATIENT
History
Characteristic features of uric acid nephrolithiasis include:
1. Abdominal pain
2. Flank pain with radiation towards the groin
3. Nausea and/or emesis
4. High purine (meat) diet
5. Gout
6. Obesity
7. Diabetes or metabolic syndrome
8. Personal or family history of nephrolithiasis
Physical Examination
1. Costovertebral angle tenderness
2. Presence of urinary crystals
3. Hematuria (gross or microscopic). However, 15% of all patients
with stones may not demonstrate even microscopic hematuria.
4. Aciduria
5. Physical examination findings associated with certain specific
conditions like cancer or various metabolic syndromes can be
seen.
These clinical features are 80% sensitive and 99% specific in
determining urinary stones but are not specific for uric acid
calculi.  Comprehensive past medical and family history should be
obtained, focusing on problems related to uric acid stone formation
like cancers, myeloproliferative neoplasms, inherited disorders
related to hyperuricosuria, indigestion, and chronic diarrhea. 
DIAGNOSIS FOR KIDNEY STONE

If the doctor suspects that you have a kidney stone, you may have
diagnostic tests and procedures, such as:

 Blood testing. Blood tests may reveal too much calcium or uric acid
in your blood. Blood test results help monitor the health of your
kidneys and may lead your doctor to check for other medical
conditions.

 Urine testing. The 24-hour urine collection test may show that you're
excreting too many stone-forming minerals or too few stone-
preventing substances. For this test, your doctor may request that
you perform two urine collections over two consecutive days.

 Imaging. Imaging tests may show kidney stones in your urinary

tract. High-speed or dual energy computerized tomography (CT) may
reveal even tiny stones. Simple abdominal X-rays are used less
frequently because this kind of imaging test can miss small kidney
stones.

Ultrasound, a noninvasive test that is quick and easy to perform, is

another imaging option to diagnose kidney stones.

 Analysis of passed stones. You may be asked to urinate through a

strainer to catch stones that you pass. Lab analysis will reveal the
makeup of your kidney stones. Your doctor uses this information to
determine what's causing your kidney stones and to form a plan to
prevent more kidney stones.
 CASE STUDY ON THE AFFECTED PERSON

NAME: KARUPPUSAMY

AGE: 50 YEARS

SEX: MALE

ADDRESS : 7/9H,ARIMA NAGAR,PALANI.

RESIDENCY: PALANI

BLOOD GROUP : A1[+VE]

CHIEF COMPLAINTS : ABDOMINAL PAIN

FAMILY HISTORY : NO SIGNIFICANT FAMILY HISTORY

PAST HISTORY: KNOWN DIABETIC FOR 10 YEARS

BIO DATA OF THE PATIENT :

DATE OF BIRTH : 03.04.1972

RELIGION : HINDU

WEIGHT : 76

HEIGHT: 172 CM

TEMPERATURE: 98.4F
HISTORY AND PHYSICAL EXAMINATION

INFECTIOUS DIDEASE : NO

ALLERGY TO DRUGS : NO

BLEEDING GUMS : NO

BACK PROBLEM : YES

HEAD INGURY: NO

SMOKING : NO

ALCOHOL : NO

DRUGS: NO

TEA / COFFEE : YES

MARITAL STATUS : MARRIED

SURGICAL HISTORY :

Under went laser treatment for kidney stone in 2017.

PERSONAL HISTORY

HOSPITALIZATION : FOR SURGRIES EARLIER

RECENT ILLNESS : NO

ANY SURGERY : AS MENTIONED UNDER ‘SURGICAL HISTORY’

REGULAR MEDICATION : NO

BODY MASS INDEX : 25.7

 MANAGEMENT AND TREATMENT

How are uric acid stones treated?

Small stones (less than 7 millimeters in diameter) may pass on their own. It
can take up to three weeks to pass. Even if the stones pass on their own, it’s
still important to talk to your provider so you can prevent stones from
forming again.

The most important step in uric acid stone treatment is drinking plenty of
water to:

 Reduce the concentration of minerals in urine. Fluids dissolve the

minerals, allowing them to leave your body through urine.
 Encourage you to pee often, which flushes away materials that may
form stones.

Providers recommend that you drink enough to produce about 2.5 liters of
urine. To produce that much urine, you need to drink a little more than 2.5
liters of fluid. That’s because you lose fluid through sweating or exercise.
Aim for drinking about 3 liters (or about 3.1 quarts) of fluids per day.

Although drinking any fluid counts, it’s best to drink water. Your provider
may prescribe medications as well to make the urine less acidic.

Can medication treat uric acid stones?

Your provider may prescribe medications to:

 Reduce uric acid levels in your blood and urine.

 Keep your urine alkaline (the opposite of acidic).
 Dissolve the uric acid stones.
Alpha blockers are a type of medication that may help stones in the ureter
pass faster. Your provider will talk to you about this option if it’s right for
you.

Will I need surgery for uric acid stones?

You may need surgery if the stones:

 Are very large.

 Block the flow of urine.
 Cause infection.
 Do not pass after four to six weeks.

Treatment options include minimally invasive or noninvasive techniques:

 Shockwave lithotripsy: This noninvasive procedure uses high-

energy sound waves to break up the stones. Shockwave
lithotripsy does not use an incision and nothing enters your body.
 Ureteroscopy: During a ureteroscopy, your provider inserts an
endoscope (a thin tube) through the ureter, the tube that leads from
each kidney to the bladder. The provider removes the stone using a
tiny basket. In some cases, the provider can break the stone into
smaller pieces using a laser, and then remove the pieces.
 Percutaneous nephrolithotomy (PCNL): Providers use PCNL for
larger stones. A surgeon makes a small incision in your back to
access the kidney. They either remove the stone or break it up first
and then remove it.

Your provider will send the stone or pieces of the stone to a lab for
analysis.
Small stones with minimal symptoms

Most small kidney stones won't require invasive treatment. You may be
able to pass a small stone by:

 Drinking water. Drinking as much as 2 to 3 quarts (1.8 to 3.6 liters) a

day will keep your urine dilute and may prevent stones from forming.
Unless your doctor tells you otherwise, drink enough fluid — ideally
mostly water — to produce clear or nearly clear urine.
 Pain relievers. Passing a small stone can cause some discomfort. To
relieve mild pain, your doctor may recommend pain relievers such as
ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
 Medical therapy. Your doctor may give you a medication to help pass
your kidney stone. This type of medication, known as an alpha
blocker, relaxes the muscles in your ureter, helping you pass the
kidney stone more quickly and with less pain. Examples of alpha
blockers include tamsulosin (Flomax) and the drug combination
dutasteride and tamsulosin (Jalyn).

Large stones and those that cause symptoms

Kidney stones that are too large to pass on their own or cause bleeding,
kidney damage or ongoing urinary tract infections may require more-
extensive treatment. Procedures may include:

 Using sound waves to break up stones. For certain kidney stones —

depending on size and location — your doctor may recommend a
procedure called extracorporeal shock wave lithotripsy (ESWL).
ESWL uses sound waves to create strong vibrations (shock waves) that
break the stones into tiny pieces that can be passed in your urine. The
procedure lasts about 45 to 60 minutes and can cause moderate pain,
 so you may be under sedation or light anesthesia to make you
comfortable.
ESWL can cause blood in the urine, bruising on the back or abdomen,
bleeding around the kidney and other adjacent organs, and discomfort
as the stone fragments pass through the urinary tract.
 Surgery to remove very large stones in the kidney. A procedure
called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me)
involves surgically removing a kidney stone using small telescopes
and instruments inserted through a small incision in your back.
You will receive general anesthesia during the surgery and be in the
hospital for one to two days while you recover. Your doctor may
recommend this surgery if ESWL is unsuccessful.
 Using a scope to remove stones. To remove a smaller stone in your
ureter or kidney, your doctor may pass a thin lighted tube
(ureteroscope) equipped with a camera through your urethra and
bladder to your ureter.
Once the stone is located, special tools can snare the stone or break it
into pieces that will pass in your urine. Your doctor may then place a
small tube (stent) in the ureter to relieve swelling and promote
healing. You may need general or local anesthesia during this
procedure.
 Parathyroid gland surgery. Some calcium phosphate stones are
caused by overactive parathyroid glands, which are located on the
four corners of your thyroid gland, just below your Adam's apple.
When these glands produce too much parathyroid hormone
(hyperparathyroidism), your calcium levels can become too high and
kidney stones may form as a result.
Hyperparathyroidism sometimes occurs when a small, benign tumor
forms in one of your parathyroid glands or you develop another
condition that leads these glands to produce more parathyroid
 hormone. Removing the growth from the gland stops the formation of
kidney stones. Or your doctor may recommend treatment of the
condition that's causing your parathyroid gland to overproduce the
hormone.

PREVENTION

How does drinking water help reduce the risk of uric acid stones?

Drinking a lot of water is one of the best things you can do to reduce the
risk of uric acid stones and other kidney stones. Fluids help make your
urine less concentrated with waste products. The water helps your body
wash away chemicals, so stones don’t form.

You can check the color of your urine to see if you’re drinking enough.
Dark-colored pee means you’re not drinking enough. Pee should be light
yellow or clear.

What diet can help prevent uric acid stones?

Avoid or limit foods high in purines. Too much of this chemical causes your
body to produce more uric acid. A high uric acid level leads to more acid
in your urine, which results in uric acid stones forming.To prevent uric
acid stones, cut down on high-purine foods, including:

 Red meat.
 Organ meats.
 Beer and alcohol.
 Meat-based gravies.
 Sardines, anchovies and shellfish.

Eat more:

 Vegetables and fruits.

 Whole grains.
 Low-fat dairy products.
It also helps to limit sugary foods and drinks, especially those that have
high-fructose corn syrup. And try to avoid crash diets, which can increase
uric acid levels in your blood.

How else can I prevent uric acid stones?

Prevention of kidney stones may include a combination of lifestyle changes

and medications.

Lifestyle changes

You may reduce your risk of kidney stones if you:

 Drink water throughout the day. For people with a history of kidney

stones, doctors usually recommend drinking enough fluids to pass
about 2.1 quarts (2 liters) of urine a day. Your doctor may ask that
you measure your urine output to make sure that you're drinking
enough water.
If you live in a hot, dry climate or you exercise frequently, you may
need to drink even more water to produce enough urine. If your urine
is light and clear, you're likely drinking enough water.

 Eat fewer oxalate-rich foods. If you tend to form calcium oxalate

stones, your doctor may recommend restricting foods rich in oxalates.
These include rhubarb, beets, okra, spinach, Swiss chard, sweet
potatoes, nuts, tea, chocolate, black pepper and soy products.
 Choose a diet low in salt and animal protein. Reduce the amount of
salt you eat and choose nonanimal protein sources, such as legumes.
Consider using a salt substitute, such as Mrs. Dash.
 Continue eating calcium-rich foods, but use caution with calcium
supplements. Calcium in food doesn't have an effect on your risk of
kidney stones. Continue eating calcium-rich foods unless your doctor
advises otherwise.
Ask your doctor before taking calcium supplements, as these have
been linked to increased risk of kidney stones. You may reduce the risk
by taking supplements with meals. Diets low in calcium can increase
kidney stone formation in some people.
Ask your doctor for a referral to a dietitian who can help you develop
an eating plan that reduces your risk of kidney stones.
 BIBLIOGRAPH

 www.mayoclinic.org

 www.ncbi.nlm.nih.gov

 WWW.wikipedia.org

 kidneystonesclinic.in