Unit 2 Test- Renal Calculi (Kidney Stone):
Put pt on side with the side up of the affected kidney and they go in with a small incision into the kidney itself to break up the stones that are in the kidney.
percutaneous lephrholithotomy
__ can be given if there is an alkaline pH imbalance
potassium citrate
caused by the development of a small crystal or many small crystals that lodge anywhere in the urinary tract
renal calculi (kidney stones)
as the kidney stone goes down the ureter, it...
scrapes the edges, causing the tissue to bleed
whenever a stone is removed, a __ analysis is performed
stone
renal colic occurs when...
stone obstruction causes ureteral spasms
antibiotics may be used as a preventative measure b/c it can prevent...
struvite stones that deals with bacteria proteus
why is a stone analysis performed?
they want to know what the stone is made out of so they can figure out how the pt can prevent them in the future
diuretics such as __ helps prevent calcium stones
thiazide
Decreases the urine calcium excretion and we want to make sure that we do not have a lot of calcium in the urine and that will help prevent calcium phosphate stones
thiazide diuretics:
incision in the ureter to remove the stone
ureterolithotomy
the allopurinol can be given and that helps with...
uric acid
stone formed else where in the urinary tract
urolithiasis
why may the pt be put on Allopurinol?
you use Allopurinol to treat gout b/c it decreases the uric acid
kidney stones are common in...
young and middle adulthood
-Uses shock waves -The pt is put on a table and the shock waves goes through the table and into the patient and it breaks up the stones using the waves -Pt is under general anesthesia
!!!
-Usually the most common surgical intervention is going to be a cystoscopy with a uretroscopy: -You go into the bladder -You go into the urethra with a scope -Go into the bladder -Then go into the ureter that has the blocked or the stone there and you use a laser to break up the stone -Then they can put in a stent to help pass the stone
!!!
-When urine is stagnant, it can lead to infection -when it is stagnant it has time to sit there and form those stones
!!!
Make sure that individuals realize that TUMS have a lot of __ in it, so if they are taking TUMS for acid reflux or heart burn that it can increase their amount of calcium in the blood and urine, so they can have an increased chance of kidney stones
!!!
Tissue trauma: you are trying to get a large stone through a small tube of the ureters and that can cause tearing of the tissue
!!!
a pt who has kidney stones in addition to fever, chills, urgency, and dysuria can have a UTI along with it
!!!
a pt with a kidney stone may have SI&SY of urine distention and tissue trauma
!!!
increased urine concentration can cause kidney stones, but if you are hydrated and your re flushing the kidneys, it is not going to have time to increase that urine concentration and be stagnant
!!!
pain can take you nauseous b/c it has to do with the sympathetic responses of the body
!!!
what are some examples of foods that are high in oxalate?
-Beans -Beer -Butter -Chocolate -Coffee -Cranberries
excess intake of __ can be a risk factor for developing a kidney stone?
-Calcium -Oxalate -Proteins *stones are made up of these contents so do not have excess amounts
what are the 4 different types of renal calculi?
-Calcium phosphate and/or oxalate -Struvite -Uric acid -Cystine
NSAIDs such as Indomethacin can be given:
-Indomethacin- NSAID *Can be given as a suppository b/c remember your pt is going to probably have nausea and vomiting
when dealing with uric acid, make sure the pt...
-Limits animal protein -Pt prescribed Allopurinol
what are the other SI&SY commonly seen with kidney stones?
-N&V -Pallor -Cool/clammy skin -Dull suprapubic pain
normally stones do not form because there are protective inorganic and organic substances in urine such as...
-Pyrophosphate -Citrate -Glycoproteins
when dealign with calcium salts, make sure to decrease __ out of the pt's diet
-Sodium -Animal protein -Avoid high oxalate foods
When the kidney stone is moving, that is when you have...
-Spasms -Increased pain
what are some factors that contribute to urolithiasis?
-Supersaturation (very high concentration of insoluble salts in the urine) -Nucleation (formation of crystals from liquid) -Lack of inhibitory substances in urine
pain makes you very...
-nauseous -vomiting -sweaty
the SI&SY of individuals with kidney stones depends on...
-size -location
what are some examples of foods that contain a lot of calcium?
-spinach -dairy -milk -cheese *use these foods in moderation
whenever the pt has these ureteral spasms, the spasms may radiate to the...
-suprapubic area -groin -external genitals
-Normally stones are not formed because of protective inorganic and organic substances in urine such as: *Pyrophosphate *Citrate *Glycoproteins -Factors that contribute to urolithiasis *Supersaturation (very high concentration of insoluble salts in the urine) *Nucleation (formation of crystals from liquid) *Lack of inhibitory substances in urine
Pathophysiology:
-Analgesia and hydration *Morphine *Indomethacin -Thiazide diuretics -Potassium citrate
Pharmacological Therapy:
-HYDRATION!!!!!!!! -Calcium stones *Decrease sodium and animal protein *Avoid high oxalate foods -Uric acid *Limit animal protein *Allopurinol -Diuretics -Antibiotics
Prevention of kidney stones:
-No demonstrative cause -Prior personal or family history of stones -Genetic predisposition -Dehydration -Immobility -Excess intake of: *Calcium *Oxalate *Proteins -Gout -Hyperparathyroidism -Urinary stasis or frequent -UTIs -Loss of calcium in bones
Risk Factors for Kidney Stones:
-Look for Ca+, phosphorus and uric acid -These are the chemical makeup of the stones -Want to know what you're dealing with
Serum levels:
-Uncommon -Gentic defect -Acid urine
Stone Type: Cystine (uncommon)
-5-10% -Due to increased uric acid in the urine -Due to increased purine intake -More common in men -Associated with individuals who have gout
Stone Type: Uric Acid
-75-80% of stones -Has to do with increases calcium in the urine
Stone Type: Calcium Phosphate and/or Oxalate:
-15-20% -Associated with UTI's -Caused by a Proteus infection -AKA Staghorn stones
Stone Type: Struvite
why is dehydration a risk factor for developing a kidney stone?
b/c it increases the urine concentration
what are some examples of gross microscopic hematuria?
b/c the individual he having some tissue trauma that is going to cause something to bleed
why is hyperparathyoidism a risk factor for developing kidney stones?
b/c the parathyroid has to do with calcium
why is urinary stasis or frequent UTI's a risk factor for developing kidney stones?
b/c the urine is stagnant and increases the urine concentration
why may a pt have gross or microscopic hematuria when they have a kidney stone?
b/c they are having some tissue trauma and that is going to cause some bleeding
why is loss of calcium in the bones a risk factor for developing kidney stones?
b/c when you lose calcium in the bones, it goes back into the blood, and then it can go into the urinary tract
why is gout a risk factor for developing kidney stones?
b/c with gout you have increased uric acid which can cause a stone
stone obstruction causes ureteral spasms b/c why?
b/c you are trying to fit a large piece through a small tube
if the pt has kidney stones, they can have more __ pain which may be intermittent or constant
back pain
what are the most common kind of kidney stones?
calcium salts
usually, what is the most common surgical intervention for kidney stones?
cystoscopy with a uretroscopy
IVP is where they use...
dye
-A stone in the ureter can block the ureter -Then the ureter gets dilated and the urine will back up into the kidney and that causes hydronephrosis. -You can have stones to lodge themselves in the urethra as well.
!!!
-If your pt is asymptomatic, you are going to be very conservative with treatment. -You are not going to go in there and do any type of surgical intervention -You will probably do a lithotripsy or you may even give the pt some diuretics and pain medications and let them pass it on their own. -But if the pt is having more symptoms of hydronephrosis, they may go in there and go ahead and get that stone on out so they can get the obstruction removed so they can have better renal function. -If the stone stays there too long, it obstructs and the urine backs up, and you can cause some renal insufficiency which we do not want
!!!
what is one of the most important ways to prevent kidney stones?
hydration!!!
if you've had a stone before it __ your chances of having a stone again
increases
when urine is stagnant, it can lead to...
infection
Look for how much Ca+, uric acid, and oxalate is in the urine b/c those are the common factors/makeup of a stone
24-hour Urine:
stone formation
lithiasis
kidney stones are more likely in...
males (2-3 more times)
they can do a renal ultrasound, but usually they do a __ and they will look to see exactly where the stone is at
CT
kidney stones are more common in...
Caucasians
-Depends on size and location *Urine distention and tissue trauma -Renal Colic *Stone obstruction causes ureteral spasm *Acute, severe flank pain on affected side -Can cause additional symptoms *Nausea/vomiting *Pallor *Cool/clammy skin *Dull suprapubic pain -Can have fever, chills, urgency, & dysuria (UTI) -Gross or microscopic hematuria
Clinical Manifestations:
-Obstruction -Hydronephrosis -Infection
Complications of kidney stones:
-Obstruction *Can lead to renal failure *Happens when the stone completely occludes the ureter *This can lead to hydrinephrosis which is an accumulation of urine in the renal pelvis as a result of the obstructed outflow -Infection b/c the urine is stagnant and not able to move
Complications of kidney stones:
surgical procedure to look in the bladder and ureters for the stone
Cystoscopy:
what is the drug of choice for those suffering in pain from kidney stones?
morphine
-UA -24 hour urine -Serum levels -KUB -Renal ultrasound -CT -Intravenous pyelogram (IVP) -Cystoscopy
Diagnostic Tests:
-Most are composed of calcium salts -Up to 720,000 stones in the US annually *Highest frequency in southern and midwestern states -More likely in males *2-3 more times -More common in Caucasians -Young and middle adulthood
Etiology:
stone formed in the kidney
nephrolithiasis
-Hydration is important b/c we want to help move that stone along -Also remember the urine is getting stagnant, and it can be backing up into that kidney b/c the ureter is blocked, and we want to try and give that pt some hydration to help the urine flow better
Hydration:
-X-Ray of the kidneys, ureter, and bladder -Helps to see if there is a stone on X-Ray
KUB:
-Very painful -Can result in obstruction &/or kidney damage -Lithiasis = stone formation -Nephrolithiasis = stone formed in kidney -Urolithiasis = stone formed else where in the urinary tract
Kidney Stones Overview:
kidney stones can result in...
obstruction and/or kidney damage
kidney stones are very...
painful
-Lithotripsy -Extra corporeal shock wave lithotripsy (ESWL) -Ureterolithotomy -Pyelolithotomy *Incision into kidney pelvis to remove the stone nephrolithotomy -Asymptomatic stones are treated conservatively
Treatment of kidney stones:
-Expect to see blood in urine -Increased WBC b/c it can lead to an infection -Look at pH
Urine Analysis (UA):
what are the SI&SY of renal colic?
acute, severe flank pain on affected side
when the pt comes in with a kidney stone, they are going to be in pain, so an __ is what they are going to ask you for first
analgesic
__ can be given as a preventative measure
antibiotics