Urinary Calculi A

Urinary Calculi
 The term renal calculus is from latin renes

meaning kidneys
 Lithiasis(stone formation ) and also known as
nephrolithiasis and It is when solid piece of

material(kidney stone) develops in the urinary
truct
 Kidney stones typicaly develops in the kidney
and leave the kidney in the urine stream in all
small stone can pass without causing
symptoms
 If the stone grows more then 5mm it can
cause blockage resulting severe pain

EPIDEMIOLOGY OF STONES
 Sex: men are affected three as commonly as women.

 Age : Peak incidence is between 3rd to 5th decade.
 Race ; Whites are affected 4 to 5 times in comparison
to black
 Urolithiasis is a life long disease with an average of 9
year intervening between episodes

ETIOLOGY AND PATHOGENESIS
Are a complex, poorly understood, it is multifactorial process.
1. Supersaturation
2. Inhibitiory substances in urine that block crystallization

eg :
Pyrophosphates, citrate, zinc, magnesium.
3. Matrix :mucoprotein often associated with urinary calculi.
Pure matrix calculi may be seen in association with proteus
infection.
 Renal stone disease is common in areas where the
temperature is hot, and people are likely to be dehydrated.
 Etiology of stone formation in the urinary tract is not very
clear.
 Proposed etiologies include:-
◦ Dietetic
 Deficiency of vitamin A causes desquamation of epithelium.
 The cells form a nidus on which a stone is deposited.
◦ Altered urinary solutes and colloids
 Dehydration increases the concentration of urinary solutes until they are
liable to precipitate.
 Reduction of urinary colloids, which adsorb solutes, or mucoproteins,
which chelate calcium, might also result in a tendency for crystal and
stone formation.
 Decreased urinary citrate
◦ The presence of citrate in urine, 300–900 mg 24 h as citric
–1
acid, tends to keep otherwise relatively insoluble calcium

phosphate and citrate in solution.
 Renal infection
◦ Infection favours the formation of urinary calculi. Clinical and
experimental stone formation are common when urine is
infected with urea-splitting streptococci, staphylococci and
especially Proteus spp. The predominant bacteria found in the
nuclei of urinary stones are staphylococci and Escherichia coli.
 Inadequate urinary drainage and urinary stasis
◦ Stones are liable to form when urine does not pass freely
 Prolonged immobilisation
Types of renal calculi
Calcium oxalate Triple phosphate Urate stone Cystine stone
They are Formed by ammonium Multiple congenital

irregular magnesium and calcium hard, error
with sharp phosphate (struvite) smooth of metabolism
projection Grows in infected alkaline Radiolucent cystinuria
Radio opaque urine Contain
-Cause bleeding Tends to be very large sulfur
(hematuria) (stag Radio-
horn) opaque
 Dirty, radio opaque
Risk Factors for Stone-Formation
Age
Gender
Season/climate
Fluid Intake
Stress/diet
Occupation
Mobility
Metabolic disorders
Genetic disorders
Anatomical abnormality
Family history
Classification of urinary calculi
 Etiology of the stone

1. primary
2. secondary.
Site of the stone
1 upper urinary tract calculi
2 lower urinary tract stones
composition of urinary stones,
3. calcium stones –oxalate and phosphate
4. infection stone (the main ingredient for magnesium ammonium phosphate and
hydroxyapatite),
5. uric acid calculi
6. cystine stones.
The purity of the stones

1. simple stones
2. mixed stones.
The former contains an ingredient, but in fact the
true pure stone is very small; the latter includes a
variety of ingredients.
Metabolic origin
3. Metabolic
4. Non metabolic.
 Radiological types
1. Radio opaque
2. Radiolucent
 Calcium containing stones

◦ 75%
◦ Radiopaque
 Non calcium containing stones

◦ 25%
◦ Radiolucent
Different types of U.calculi
stone Radio opaque
KUB KUB
Radiolucent stone
KUB IVU
Clinical features
 Renal calculi are common.
 Approximately 50% of patients present between the ages of 30 and 50
years.
 The male–female ratio is 4:3.
 May be clinically silent even when large, may cause no symptoms but
progressive destruction of the renal parenchyma
 Pain
◦ Pain is the leading symptom in 75% of people with urinary stones.
◦ Fixed renal pain is located posteriorly in the renal angle anteriorly in the
hypochondrium, or in both.
◦ It may be worse on movement, particularly on climbing stairs.
◦ There is no pyrexia.
 Stone in the ureter manifests with severe pain radiating from loin to
groin, attacks may not last longer than 8 hours
 Haematuria
 Pyuria.
 Asymptomatic
 Pain-Dependant on site of stone
- Kidney – loin pain

- Ureter – loin to groin pain
- Bladder – supra pubic
- Urethra – ‘strangury’ --- slow, painful
urination
 Gross hematuria
 Microscopic hematuria
 Severity of hematuria does not reflect size of stone
Nursing Symposium, Urofair 08

Presentation - Complications
 Infections
pyelonephritis, cystitis
 Obstruction
Upper tract:
- renal parenchyma
damage
- infection
Lower tract
- LUTS, anuria
 Renal failure
Nursing Symposium,
Urofair 08
Diagnosis :
Lab
 urinalysis, urine culture
 RFT
Rad
 KUB.
 IVU
 US stone - hydronephrosis.
 Spiral CT - rapid, does not require bowel
preparation and avoids use of IV & it has gradually replaced
IVU as primary imaging modality for acute renal colic
Ultrasound
 Kidney
- stones
- hydronephrosis /
- parenchyma disease
 Ureter
- hydroureter
 Bladder
- stones
- prostate enlargement
Nursing Symposium,
Urofair 08
Intra Venous Urogram / IVU
 Bowel preparation
 KUB before IV contrast
 Intra venous contrast material to
opacify kidney and collecting
system
 Serial films
 Stones appear as opacity or filling
defect
 Good for diagnosing stones in
entire collecting system
Nursing Symposium,
Urofair 08
(CT Scan (CT KUB
 No contrast exposure
 ‘short’ study – 10 sec
 Radio opaque and lucent stones
seen
 Hydronephrosis and hydroureter
 Evidence of inflammation
 Other organ pathology
Nursing Symposium,
Urofair 08
 Metabolic study ?
Management of urinary stones
 Conservative
 Endourological
 Surgical (open)
Conservative management
 Pain control ----- acute ureteric colic
 Infection control
 Diet control
 Hydration
Surgical management---lithotomy
 In the kideny
Nephrolithotomy, Pyelolithotomy,
Pyelonephrolithotomy,nephrectomy ( partial or total)
 In the ureter
ureterolithotomy
 Urinary bladder
vesicolithotomy
 Urethra
urethrolithotomy--- not done know

Management of renal calculi
Depend on size and site
1- ≤ 5mm---- conservative ttt
2- if more than 5 mm & less than 2 cm, it depend on
the site
Indication of open surgery
 Unfeasibility of instrument
 Lack of experience
 Failure of minimal invasive procedure.
Thank you

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Urinary Calculi

 The term renal calculus is from latin renes

nephrolithiasis and It is when solid piece of

cause blockage resulting severe pain

 Sex: men are affected three as commonly as women.

year intervening between episodes

Are a complex, poorly understood, it is multifactorial process.

2. Inhibitiory substances in urine that block crystallization

acid, tends to keep otherwise relatively insoluble calcium

They are Formed by ammonium Multiple congenital

 Etiology of the stone

The purity of the stones

 Calcium containing stones

 Non calcium containing stones

- Kidney – loin pain

Nursing Symposium, Urofair 08

urethrolithotomy--- not done know

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