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Urolithiasis: Types, Causes, and Management

Urolithiasis, or renal calculus, refers to the formation of stones in the urinary tract, causing symptoms such as excruciating pain and hematuria. This article discusses the types of stones, etiology, pathophysiology, diagnostic findings, medical and surgical management, and dietary recommendations.

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Urolithiasis: Types, Causes, and Management

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  1. WELCOME

  2. Urolithiasis. BY: Santhosh Thomas, Lecturer, YNC , 1/10/2018.

  3. Renal calculus or Urolithiasis • Urolithiasis refers to stones (calculi) in the urinary tract. Stones are formed in the urinary tract when urinary concentrations of substances such as calcium oxalate, calcium phosphate, and uric acid increase.

  4. Types Of Stones in the urinary tract. • Calcium stones • Uric acid stones • Struvite stones • Cystine stones

  5. Etiology • Certain factors favor the formation of stones, including • Infection, • Urinary stasis, and • Periods of immobility (slows renal drainage and alters calcium metabolism). • Increased calcium concentrations in blood and urine promote precipitation

  6. Causes of hypercalcemia (high serum calcium) and hypercalciuria. • Hyperparathyroidism • Renal tubular acidosis • Cancers • Granulomatous diseases (sarcoidosis, tuberculosis), which may cause increased vitamin D production by the granulomatous tissue

  7. Excessive intake of vitamin D • Excessive intake of milk and alkali • Myeloproliferative diseases (leukemia, polycythemiavera, multiple myeloma), which produce an unusual proliferation of blood cells from the bone marrow

  8. Pathophysiology. • Due to etiological factors • Formation of stones in the urinary tract(Kidneys, urinary bladder, ureters etc.) • Obstruction to the urine flow. • Increasing the hydrostatic pressure

  9. Clinical manifestations of disease.

  10. Clinical Manifestations. • Excruciating Pain. • Hematuria • Vomiting and nausea • Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia.

  11. The patient has a desire to void, but little urine is passed, and it usually contains blood because of the abrasive action of the stone. This group of symptoms is called ureteralcolic.

  12. Assessment and Diagnostic Findings. • The diagnosis is confirmed by • X-ray films of the kidneys, ureter, and bladder (KUB) • Ultrasonography, • Intravenous urography, or • Retrograde pyelography. • Blood chemistries and a 24-hour urine test for measurement of calcium, uric acid, creatinine, sodium, pH, and total volume are part of the diagnostic work

  13. COLLABORATIVE PROBLEMS/POTENTIAL COMPLICATIONS • Infection and sepsis (from UTI and pyelonephritis) • Obstruction of the urinary tract by a stone or edema with subsequent acute renal failure

  14. Medical Management. • The basic goals of management are to eradicate the stone, to determine the stone type, to prevent nephron destruction, to control infection, and to relieve any obstruction that may be present.

  15. Opioidanalgesics are administered to prevent shock and syncope that may result from the excruciating pain. • NSAIDs may be as effective as other analgesics in treating renal stone pain.

  16. Hot baths or moist heat to the flank areas may also be useful. • Fluids are encouraged. This increases the hydrostatic pressure behind the stone.

  17. Unless contraindicated, any patient with renal stones should drink at least eight 8-ounce glasses of water daily to keep the urine dilute.

  18. Dietary Recommendations for Preventionof Kidney Stones • Restricting protein to 60 g/day is recommended to decrease urinary excretion of calcium and uric acid. • A sodium restriction of 3–4 g/day is recommended. Table salt and high-sodium foods should be reduced because sodium competes with calcium for reabsorption in the kidneys.

  19. Low-calcium diets are not generally recommended, except for true absorptive hypercalciuria. Evidence shows that limiting calcium, especially in women, can lead to osteoporosis and does not prevent renal stones. • Oxalate-containing foods (spinach, strawberries, rhubarb, tea,peanuts, wheat bran) may be restricted.

  20. SURGICAL MANAGEMENT. • If the stone is not passed spontaneously or if complications occur, treatment modalities may include surgical, endoscopic, or other procedures—for example, ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), or endourologic (percutaneous) stone removal.

  21. Ureteroscopy. • It involves first visualizing the stone and then destroying it. Access to the stone is accomplished by inserting a ureteroscope into the ureter and then inserting a laser, electrohydrauliclithotriptor, or ultrasound.

  22. device through the ureteroscope to fragment and remove the stones. A stent may be inserted and left in place for 48 hours or more after the procedure to keep the ureter patent.

  23. Extracorporealshock wave lithotripsy (ESWL) • In this a high-energy amplitude of pressure, or shock wave, is generated by the abrupt release of energy and transmitted through water and soft tissues. When the shock wave encounters a substance of different intensity (a renal stone), a compression wave causes the surface of the stone to fragment.

  24. Ultrasonic lithotriopsy. • Uses high frequency sound waves delivered through an electroic probe inserted into the ureter to break up kidney stone.

  25. Electrohydraulic lithotripsy • Uses a flexible probe to break up small stones with shock waves generated by elctricity. The probe is positioned close to the stone through a flexible ureteroscope.

  26. Open Surgery to treat kidney stones. • PercutaneousNephrostolithotomy.

  27. Endourologic methods. • Endourologic methods of stone removal may be used to extract renal calculi that cannot be removed by other procedures.

  28. A percutaneousnephrostomy or a percutaneousnephrolithotomy (which are similar procedures) may be performed, and a nephroscope is introduced through the dilated percutaneous tract into the renal parenchyma. Depending on its size, the stone may be extracted with forceps.

  29. Nursing Diagnosis. • Acute pain related to inflammation, obstrucyion, and abrasion of the urinary tract • Deficient knowledge regarding prevention of recurrence of renal stones

  30. Nursing management. • Assessment • The patient with suspected renal stones is assessed for pain and discomfort as well as associated symptoms, such as nausea, vomiting, diarrhea, and abdominal distention.

  31. Planning and Goals • The major goals for the patient may include relief of pain and discomfort, prevention of recurrence of renal stones, and absence of complications.

  32. Nursing Interventions. • RELIEVING PAIN • Immediate relief of the severe pain from renal or ureteral colic is accomplished with the administration of opioid analgesic agents (intravenous or intramuscular administration may be prescribed to provide rapid relief) or NSAIDs

  33. Teaching Patients Self-Care • Because the risk of recurring renal stones is high, the nurse provides education about the causes of kidney stones and ways to prevent their recurrence . The patient is encouraged to follow a regimen to avoid further stone formation.

  34. Evaluation. • Reports relief of pain • States increased knowledge of health-seeking behaviors to prevent recurrence. • Experiences no complications.

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