RENAL

CALCULI
• Calculi form in the kidneys and bladder
when urinary constituents in solution are
precipitated.
• the solutes involve are oxalates,
phosphates, urates and uric acid
• stones usually consists of more than one
substance deposited in layers.
• more common in men, after age 30 years
of age
• most originate in collecting tubules or in
renal papillae
• then they pass into the renal pelvis where
they increase in size
• some become too large to pass through
the ureter and may obstruct the outflow of
urine causing renal failure.
• other pass to the bladder and are either
excreted or increase in size and obstruct
the urethra
• sometimes stones originate in the
bladder.
• PREDISPOSING FACTORS:
• Dehydration – this leads to increased
reabsorption of water from the tubules but
does not change solute reabsorption,
resulting in reduced volume of highly
concentrate filtrate in the collecting tubes.
• pH of urine – when the normally acid
filtrate becomes alkaline some substances
may be precipitated. This occurs when the
kidney buffering system is defective and in
some infections.
• Infection – necrotic material and pus
provide foci upon which solutes in the
filtrate may be deposited and the products
of infection may alter pH of the urine.
Infection sometimes leads to alkaline urine
• CLINICAL MANIFESTATIONS:
• depends on the presence of obstruction,
infection and edema.
• when stones block the flow of urine,
obstruction develops, producing an
increase in the hydrostatic pressure and
distending the renal pelvis and proximal
ureter.
• infection (pyelonephritis and UTI with
chills, fever and dysuria) can be a
contributing factor with struvite stones.
• stones in the renal pelvis may be
associated with an intense, deep ache in
the costovertebral region.
• hematuria is often present, pyuria is also
present.
• pain originating in the rectal area radiates
anteriorly and downward toward the
bladder in female and toward the testes in
male.
• if pain suddenly becomes acute, with
tenderness over the costovertebral area
• nausea and vomiting appear
• diarrhea and abdominal discomfort may
occur.
• stones lodged in the ureter cause acute
excruciating, colicky, wavelike pain
radiating down the thigh and to the genital.
• often the patient has a desire to void but
little urine pa