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BY: AILYN REGALADO

RENAL CALCULI
- Refers to stones in the urinary tract due to
increase urinary concentration of substances
such as Ca oxalate, Ca phosphate and uric acid.

Assessment
A.

History:

1.

Family history of renal stones

2.

Bone marrow disorders

3.

Inflammatory bowel disease

4.

Increase calcium and increase purine diet

B. Sign/Symptoms depends on obstruction and infection


5.

Dysuria

6.

Infection chills and fever

7.

Hematuria/pyuris pus

8.

Renal colic

9.

Nausea and vomiting

C. Diagnostic test:
10. Xray of KUB/ultrasonography
11. Retrograde pyelography
12. Blood chem/ 24hours urine test to measure calcium, uric acid,
sodium, creatinine, and pH
*beans, asparagus, liver, red meat, dinuguan food rich in purine

WHAT IS RENAL COLIC?


-

Severe pain in the lower back or sides. The pain is usually


on one side, but maybe on both sides of the lower back.
Renal colic may start quickly, come, and go, and become
worse over time.
Causes: blockage in urinary tract

PATHOPHYSIOLOGY OF RENAL CALCULI


Precipitating factors:

Predisposing factors:

- urinary tract infection (klebsiella)

Non modifiable

age

sex

Modifiable factors:

Diet (unusually high in soy & fish

sauce, bagoong, softdrinks, legumes,


protein & salt)

Low fluid intake

Smoking & alcoholic drinking

Uric acid, ammonia phosphate


And calcium oxalate stone material deposition
On proximal renal tubule

Super saturation of
urine by stone forming
constituents

nephrocalcinosis on proximal
tubule

Hyperkalemia
Randalls plaque

Nidation of crystals or
foreign bodies from the
supersaturated urine.

Low back pain

UTI cause by urea


splitting microorganism
Increase production
of WBC

Pyuria

Progression of stone to
Loop of Henle

Accumulation of
stones and
increasing in size

Dysuria

Blood vessel wall


surface attraction
and erosion

Hematuria

Stone formation in
kidney

Proteinuria

Increase size of kidney stones

Stone matrix progression


Multiple urinary calculus

If treated

If not treated

Lithotripsy
percutaneous
nephrolithotomy
surgery
Ureteroscopy

Kidney failure

Wellness

Death

Goal of care: relief pain and discomfort, prevention or recurrence or


renal stones and absence of complication
1.

Medication (analgesics, NSAID)

2.

Monitor pain level closely

3.

Prepare patient for other treatment (lithotripsy treatment to


dissolve kidney stones, and surgery)

4.

Increase fluid intake

5.

Strain all urine

6. Patient education for complications and follow-up care


. ESWL extracorporeal (outside the body) shock wave
lithotripsy is the most common type of lithotripsy
. Straining urine fine mesh strainer or fine gauze