2. Definition
Renal calculi are Stones which is small, harden
deposits of mineral and acid salts on the inner
surfaces of the kidneys They originate as
microscopic particles and develop into stones
over time. The medical term for this condition is
nephrolithiasis, or renal stone disease
Alternative names include:
Renal Lithiasis
Nephrolithiasis (Kidney Stone Disease)
11. BLOOD
CONSTITUENTS IN
GLOMERULAR
FILTRATE
• WATER
• MINERAL SALTS
• AMINOACIDS
• KETOACIDS
• GLUCOSE,HORMONES
• UREA, CREATININE
• URIC ACID
• TOXINS
• SOME DRUGS
BLOOD
CONSTITUENTS
REMAINING IN
GLOMERULUS
• LEUKOCYTES
• ERYTHROCYTES
• PLATELETS
• PLASMA PROTEINS
• SOME DRUGS
12.
13.
14. ETIOLOGY
Immobility and sedentary life style
Dehydration /decreased fluid intake
Previous history of urinary calculi
A diet rich in prurines ,oxalates
Genetic predisposition
Warm climate
Large intake of dietary protein
Living in mountains ,deserts/tropical
areas
17. Stone Formation
Kidney stones form when there is a high level
of mineral (s) ; i.e. calcium (hypercalciuria),
oxalate (hyperoxaluria), or uric acid
(hyperuricosuria) in the urine;
Urine normally contains chemicals—citrate,
magnesium, pyrophosphate—that prevent the
formation of crystals.
18. Low levels of these inhibitors can contribute to
the formation of kidney stones.
Citrate is thought to be the most important
The chemical composition of stones depends
on the chemical imbalance in the urine.
The four most common types of stones are
comprised of calcium, uric acid, struvite, and
cystine.
Cont.
19. TYPES OF STONES
CALCIUM CONTAINING STONES
URIC ACID STONES
STRUVITE –CARBONATE STONES
CYSTINE STONES
DRUG RELATED STONES
20. CALCIUM CONTAINING
STONES
Approximately 85% of stones are composed
predominantly of calcium compounds.
The most common cause of calcium stone
production is excess calcium in the urine
(hypercalciuria).
In hypercalciuria, excess calcium builds up in
the kidneys and urine, where it combines
with other waste products to form stones.
Low levels of citrate, high levels of oxalate
and uric acid, and inadequate urinary volume
may also cause calcium stone formation.
21. Calcium stones are composed of oxalate (calcium
oxalate) or phosphate (calcium phosphate).
Calcium phosphate stones typically occur in
patients with metabolic or hormonal disorders such
as hyperparathyroidism and renal tubular acidosis.
These stones come in 2 different types -
monohydrate and dihydrate.
Calcium oxalate dihydrate stones usually break
easily with lithotripsy.
Monohydrate stones are among the most difficult
stones to fragment.
Cont.
22. Cause of hypercalciuria.
Increased intestinal absorption of calcium
(absorptive hypercalciuria),
excessive hormone levels
(hyperparathyroidism),
and renal calcium leak (kidney defect that
causes excessive calcium to enter the
urine)
Prolonged inactivity also increases urinary
calcium and may cause stones.
Renal tubular acidosis (inherited condition
in which the kidneys are unable to excrete
acid) significantly reduces urinary citrate
and total acid levels and can lead to stone
formation.
26. Struvite Stones
Also called an infection stone, develops when a
urinary tract infection (e.g., bladder infection)
affects the chemical balance of the urine.
Bacteria in the urinary tract release chemicals
that neutralize acid in the urine, which enables
bacteria to grow more quickly and promotes
struvite stone development.
They are capable of splitting urea into
ammonia, decreasing the acidity of the
urine and resulting in favorable conditions
for the formation of struvite stones.
27. Cont.
Organisms which alkalinize the urine
can cause struvite stones to form.
Struvite stones are more common in
women.
The stones usually develop as jagged
structures called "staghorns" and can
grow to be quite large.
28. STRUVITE –CARBONATE
STONES
Urease producing bacteria include-
Proteus , Morganella, Providencia ,
Pseudomonas
Risk factors –women with recurrent UTI
Patients with spinal cord injury
Men with indwelling bladder catheter and
complete spinal cord transection have
higher risk
30. CYSTINE STONES
Cystinuria is the result of an autosomal
recessive defect in proximal tubular and
jejunum reabsorption of the dibasic
amino acids cysteine ,ornithine lysine,
arginine
It constitutes of <1% of all stones
Characteristic hexagonal crystals
present in morning urine
36. MANAGEMENT
INCREASE FLUIDS
REDUCE PAIN
PREVENT STONE RECURRENCE
IMPLEMENT DIETARY CHANGES
ADMINISTER MEDICATIONS
37. DIETARY MANAGEMENT
For calcium stones ,high calcium rich
diet,and avoid oxalate rich food
For clients with uric acid stones, a low
diet in purines
Foods that tend to alkalinize the urine are
recommended
High fluid intake (3L /day)
A low sodium diet
38. High doses of vitamin C (i.e., more than 500 mg
per day) can result in high levels of oxalate in
the urine (hyperoxaluria) and increase the risk
for kidney stones. Oxalate is found in berries,
vegetables (e.g., green beans, beets, spinach,
squash, tomatoes), nuts, chocolate, and tea.
Stone formers should limit their intake of
cranberries, which contain a moderate amount
of oxalate.
43. NURSING MANAGEMENT
PREOPERATIVE CARE
Assess knowledge and understanding of
the procedure
Withhold food and fluids and for bowel
preparation prior to surgery
44. NURSING MANAGEMENTNURSING MANAGEMENT
• Acute pain related to effect of renal
stone and inadequate pain control or
comfort measures
• Impaired urinary elimination related to
trauma or blockage of ureters or
urethra
• Ineffective therapeutic regimen
management related to lack of
knowledge regarding disease process
prevention of recurrence , diet and fluid
requirements
45. HEALTH EDUCATION
Encourage fluid to accelerate passing of
stone particles
Teach about analgesics for colicky pain
and passage of stone debris
Encourage frequent walking to assist in
passage of stone fragments
46. • For patient with calcium oxalate stones
• Instruct to maintain dietary pattern
• Teach purpose of drug therapy
• For patients with uric acid stones
• Teach methods to alkalinze urine to
enhance urate solubility
• Teach the purpose of taking
Allopurinol
• Provide information about reduction
of dietary purine intake
47. For patients with infection stone
Encourage to report signs and symptoms
of urinary infections
For patients with cystine stones
teach patient about drug therapywith D-
pencillamine(Depen)
Instruct the patient to test urine pH
Notes de l'éditeur
pain typically starts at side or back, just below your ribs, and radiates to ones lower abdomen and groin. Often begins when stone reaches ureters