Renal Calculi

Strain all urine because

the build up could be specifically one chemical that is not being excreted

Stone analysis: struvite

-associated with chronic UTI 1. bacteria split urea into ammonia that binds to phosphate and Mg -associated with proteus, klebsiella, and pseudomonas but not E-Coli -formation increases with alkaline urine

Stone analysis: Uric acid

-associated with high levels or uric acid and acidic urine

Stone analysis: calcium phosphate

-results from high urinary calcium concentration

Stone analysis: calcium oxalate

-results from high urinary oxalate levels

Medical management of kidney stones diagnostics

1. CT is test of choice -can also include KUB, IVP 2. labs -CBS, chemistries, UA C+S

Medications for large stones

1. alpha blockers -Tamsulosin (Flomax) 2. calcium channel blockers -Nifedipine (procardia)

Process of stone formation

1. condition necessary for stone formation -supersaturation of urine with stone components

Factors that cause supersaturation and contribute to stone formation

1. dehydration 2. urinary stasis 3. hypercalcemia 4. hyperparathyroidism 5. CAs 6. excessive vitamin D -makes you absorb more Ca 7. many idiopathic

Intervention for large stones

1. extracorpeal shock wave lithotripsy (ESWL) 2. percutaneous nephrolithotomy 3. ureterscopy for distal stones

Urinary/Renal Calculi

1. frequent cause of hospitalization 2. affects men MORE than women 3. 50% recurrence rate

Management of calcium phosphate

1. high fluid intake 2. treat underlying disorders that raise serum calcium 3. low sodium diet 4. restricted protein 5. thiazide diuretics (HCTZ) 6. calcium restriction not recommended

Complications of kidney stones

1. infection 2. hydronephrosis -swelling of kidney due to build up of urine 3. renal failure

Management of calcium oxalate

1. low oxalate diet -spinach -strawberries -tea -rhubarb -peanuts -chocolate -wheat bran

Tx for uric acid

1. low purine diet -organ meats -shelfish -alc -fatty foods 2. allupurinol (zyloprim) 3. potassium citrate can alkalinize the urine

Treatment of kidney stones

1. pain management -IV narcotics or NSAID 2. fluids -goal is urine output >2 L per day 3. stone analysis -strain all urine 4.dependent on size of stone -less than 1 cm allow to pass ->1 cm requires intervention

Clinical manifestations of having stones

1. pain/renal colic -pain in back or flank if stone lodged in renal pelvis -wavelike pain in flank radiating to the groin if stone is in ureter 2. hematuria

Condition that suppresses stone formation

1. presence of citrate (normal by-product of citric acid cycle in the kidney) in the urine -binds CA crystals -citrate levels decreased in metabolic acidosis or hypokalemia

Renal calculi

1. stone in the kidney

Urinary calculi

1. stones in the urinary tract

nephrolithiasis

1. stones that form in the kidney

urolithiasis

1. stones that form in the urinary tract -ex: bladder

Tx of struvite

1. treat chronic UTI 2. acidify urine with cranberry juice

Renal Calculi

Kidney stones, or renal calculi, are solid masses made of crystals. Kidney stones originate in your kidneys, but can be found at any point in your urinary tract. The urinary tract includes the kidneys, ureters, bladder, and urethra. Kidney stones are known to be one of the most painful medical conditions.