 Kidney Stones are small, hard

deposits of mineral and acid salts

on the inner surfaces of the
kidneys
 Alternative names include:
› Renal Lithiasis
› Renal Calculi
› Nephrolithiasis (Kidney Stone
Disease)
 80% of stones under 2mm in size
 90% of stones pass through the urinary
system spontaneously
› Generally stone smaller than 6mm are
passable.
› Stone is mostly present in North zone of
India .
 Causes:
› Highly concentrated urine, urine stasis
› Imbalance of pH in urine
 Acidic: Uric and Crystine Stones
 Alkaline: Calcium Stones
› Gout
› Hyperparathyroidism
› Inflammatory Bowel Disease
› UTI
› Medications
 Lasix, Topamax, Crixivan
Calcium stone
Struvite
Uric Acid
Cystine
 80% of patients with nephrolithiasis form calcium
stones:
› Mostly: Ca-Oxalate
› Less often: Ca-Phosphate
 Type of salt depends on:
› pH of urine &
› Availability of oxalate
› white, hard & radio-opaque
› Ca-Oxalate: smaller, lodge in ureter
› Ca-Phosphate: staghorn, in renal pelvis (big)
Main causes favouring formation
of calcium salts stones:

1- Hypercalciuria:
 Defined as daily urinary Ca excretion >6.2 mmol in
female & >7.5 mmol in male.
 due to hypercalcemia (most often due to 1ary
hyperparathyroism
 sometimes, Ca++ salts stones are found with no
hypercalcemia
2-Hyperoxaluria (more important )
 favours formation of calcium oxalates (even with
no hypercalciuria)
 causes:
• exogenous (diet rich in oxalate )
• absorption (in fat malabsorption)
• 1ary hyperoxaluria: inborn errors , in childhood , urinary
oxalates > 400 mol/24 hours
 Approximately 8% of renal stones contains uric acid
 may be associated with hyperuricemia (with or
without clinical gout)
 Acidification of urine favours Uric acid precipitation
 Characteristics:
› small, friable & yellowish
› may form staghorn (if big)
› radiolucent (can’t be seen be plain X-ray)
› visualized by ultrasonography or I.V. Pyelogram
 Incidence of struvite stone is
approximately 10% of all renal
stones.
 Rare
 occurs in cases of homozygous cystinuria (inborn
error of amino acid metabolism)
 Soluble in alkaline urine (precipitates by acidic urine)
 Family history
 Current medications
 Frequency of urination
 Do you experience pain while urinating?
 What is your typical diet?
 How did patient’s kidney stones resolve
themselves in the past?

http://erstories.net/wp-content/uploads/2008/10/kidneystone1a.jpg
Blood Urea Nitrogen

Creatinine

Urine Analysis
 Test and Diagnostics:
› Blood Analysis
› Urine Analysis
› CT Scan
› Abdominal x-ray
› Ultrasound
› Retrograde Pyelogram
› Cystoscopy
› Intravenous pyelography

 Do you have a history of renal failure?
› Contraindicated with renal failure
 Have you ever have a reaction to iodine?
› Contrast contains iodine
 Is there a possibility you could be pregnant?
 Are you currently taking any medications?
› Metformin may react with contrast
› Contrast contains iodine

 Check BUN and Creatinine levels prior to IVP

 Two Focuses of Treatment:
› Treatment of acute problems, such as pain, etc
› Identify cause and prevent kidney stones from
reoccurring

 Acute Treatment:
› Pain Medication!!!
› Strain urine for stones
› Keep Hydrated
› Ambulation
› Diet Restrictions
› Emotional Support
› Invasive Procedure (may be necessary)
http://www.free-press-release.com/members/members_pic/200906/img/1245774370.jpg
 Lithotripsy: used to break into smaller
fragments allowing it to pass through the
urinary tract.
› Extracorporeal Shock-Wave (ESWL)
› Percutaneous Ultrasonic
› Electrohydraulic
› Laser
 Surgical Therapy
› Nephrolithotomy (Kidney)
› Pyelolithotomy (Renal Pelvis)
› Ureterolithotomy (Ureter)
 Basket Extraction http://www.svhm.org.au/Department_Index/Lithotripsy/images/Kidney-Stones.gif
1.CALCIUM STONES:-
Conservative lines of treatment:
 Treatment of primary condition (i.e. Infection,
hypercalcemia, hyperoxaluria)
 Reducing oxalates in diet (it is not recommended to
reduce calcium in diet)
  Fluid intake (if no glomerular failure).
 Acidification of urine (as ppt. is favoured by alkaline
conditions)
 2) URIC ACID STONE

 Treatment:
› Treatment of cause of hyperuricemia
›  purine-rich diet
› Alkalinzation of urine (e.g. by potassium citrate)
› fluid intake
3) STRUVITE STONE

Treatment:
› Aggressive prevention & treatment of the cause (urinary tract
infection)
› Urine acidification
›  Fluid intake
› It may require complete stone removal (percutaneous
nephrolithotomy)
4) CYSTINE STONE

Treatment:
›  fluid intake
› Alkalinzation of urine
› Penicillamine
 Acute pain r/t obstruction from renal
calculi as manifested by patient being,
pacing around the room, and patient
verbalizing pain upon assessment.

Goal: patient will state pain is at a manageable

level within 2 hours of admission.

What are Nursing Interventions?

 Administer pain medication as ordered by physician.

 Provide non-pharmaceutical techniques such as imagery and/or

meditation to relieve pain.

 Patient will determine manageable pain level.

 Patient will be asked about any concerns and/or fears that may be
associated with pain.

 Provide emotional support for the patient.

 Reassess patient’s pain levels within 1 hour after

administration of pain medications.
Deficient knowledge r/t fluid requirements and dietary
restrictions as manifested by reoccurring stones.
Goal: Patient will state methods to prevent future stones by the time
patient is discharge. A plan of care will also be created with the
patient before patient is discharge to prevent reoccurrence of
kidney stones.

Risk for infection r/t kidney stone obstruction of urinary tract

causing stasis of urine.
Goal: Patient’s urine will be yellow and clear upon discharge and
patient will not have a fever. Urine analysis will show no
indication of UTI or other infection.

What are Nursing Interventions?