renal calculi•nephrolithiasis refers to renal stone disease; urolithiasis refers to the presence...
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Renal calculi
Presented by:- Bhagawati ray
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DEFINITION• Nephrolithiasis refers to renal stone
disease; urolithiasis refers to the presence of stones in the urinary system. Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine
•
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ETIOLOGYMETABOLIC
LIFESTYLE
GENETIC FACTORS
DRUGS
OTHERS
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RISK FACTORS
METABOLIC
HISTORY OFRENAL
DISTURBANCES CALCULI DEHYDRATION
SEDENTARY LIFE STYLE
IMMOBILITY
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RISK FACTORSHIGH MINERAL CONTENT IN DRINKING WATER
DIETARY INTAKE
UTI & H/O FEMALE GENITALMUTILATION
PROLONGED INDWELLING CATHETERISATION
NEUROGENIC BLADDER
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PATHOPHYSIOLOGY
• Slow urine flow, resulting in
supersaturation of the urine
with the particular element
that first become crystallized
and later become stone
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PATHOPHYSIOLOGY
• Damage to the lining of the
urinary tract
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PATHOPHYSIOLOGY
• Decreased inhibitor
substances in the urine that
would otherwise prevent
supersaturation and
crystalline aggregation
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TYPES OF STONES• Calcium Phosphate
• Calcium oxalate
• Uric acid
• Cystine
• Struvite
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CLINICAL MANIFESTSTIONS• Severe
abdominal or flank pain
• Frequency and dysuria
• Oliguria and anuria in obstruction
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CLINICAL MANIFESTSTIONS
• Hematuria
• Renal colic
• Nausea
• hydronephrosis
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DIAGNOSTIC STUDIES
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DIAGNOSTIC STUDIES
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DIAGNOSTIC STUDIESC
YSTO
SCO
PY
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DIAGNOSTIC STUDIES
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DIAGNOSTIC STUDIES
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DIAGNOSTIC STUDIES
RETROGRADE
PYELOGRAM
CT SCAN
24 HOUR URINE
SPECIMEN
LAB INVESTIGATIONS
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MANAGEMENT
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MEDICAL
• DRUG THERAPY- Opioid
agents NSAIDS
Spasmolytic agents
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COMPLIMENTARY THERAPY
• Hypnosis, imagery, therapeutic or healing touch, acupuncture and breathing techniques
• Positioning the client to comfortable position aids in pain reduction
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OTHER TECHNIQUES• Avoiding over
hydration and under hydration
• Strain the urine
• Send any strained stone to laboratory to aid in preventive treatment in the future
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SPECIFIC APPROACHESURINARY
STONE
CHARACTERIS
TICS
PREDISPOSING
FACTORS
THERAPEUTIC MEASURES
Calcium
oxalate
35-40
Small
often
possible to
get
trapped in
ureter
,more
frequent in
men
Idiopathic
hypercalciuria
hyperoxaluria
,Independent
of urinary pH
,family history
Increase hydration
Reduce dietary oxalate
Give thiazide diuretics
cellulose phosphate,(chelate
calcium and prevent GI
absorption),
potassium citrate(alkaline
urine),
cholestyramine(bind
oxalate),
calcium lactate(precipitate
oxalate in GI tract)
Reduce daily sodium intake
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SPECIFIC APPROACHESURINARY
STONE
CHARACT
ERISTICS
PREDISPOSING
FACTORS
THERAPEUTIC MEASURES
Calcium Mixed Alkaline urine, Treat underlying
phosphate stones primary cause and other
8-10% with hyperthyroidism stones
struvite
or
oxalate
stones
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SPECIFIC APPROACHESURINARY
STONE
CHARACTERIS
TICS
PREDISPOSING
FACTORS
THERAPEUTIC MEASURES
Struvite 3 to 4 times urinary tract Antimicrobial agents
10-15 % common in infections acetohydroxamicacid
women ≥ Surgical interventions
men,always Measures to acidify urine
in
association
with urinary
tract
infection
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SPECIFIC APPROACHES
URINARY
STONE
CHARACTERI
STICS
PREDISPOSING
FACTORS
THERAPEUTIC MEASURES
Uric
acid
5-8 %
Predomi
nant in
men high
incidence
in jewish
men
Gout, acid
urine
,inherited
conditions
Reduce urinary
concentration of uric acid
Alkanize urine with
potassium citrate
Administer allopurinol
Reduce dietary purines
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SPECIFIC APPROACHES
URINARY
STONE
CHARACTERISTICS PREDISPOSING
FACTORS
THERAPEUTIC MEASURES
Cystine
1-2 %
Genetic
autosomal
recessive
defect,defective
absorption of gi
cystine from gi
tract and kidney
excess
concentrations
causing stone
formation
Acid urine Increase hydration
Give α pencillamine and
tiopronin to prevent cystine
crystallization
Potassium citrate to
alkaline urine
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SURGICAL MANAGEMENT
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PROXIMAL URETER
ESWL
RETROGRADE
ANTEGRADENEPHROURETER
OLITHOTOMY
URETEROSCOPY
STENTING ALONE
PERCUTANEOUS URETERO
LITHOTOMY
NEPHROLITHOTOMY
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MID URETER
RETROGRADE URETEROSCOPY
ESWL
ANTEGRADE NEPHROSTOURETE
ROLITHOTOMY
OPEN URETERO-LITHOTOMY
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DISTAL URETER
ESWL/ureteroscopy
Antegrade nephrostoureterolithotomy
Stenting alone
Open ureterolithotomy
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SURGICAL MANAGEMENT
LASER
PERCUTANEOUS
ESWL
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OPEN SURGICAL PROCEDURES
NEPHROLITHO TOMY
PYELOLITHOT OMY
URETHROLIT HOTOMY
CYSTOTOMY
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PREVENTION
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PREVENTION
• Avoid protein intake; usually protein is
restricted to 60g/day to decrease urinary
excretion of calcium and uric acid.
• A sodium intake of 3 to 4 g/day is
recommended.Table salt and high-sodium
foods should be reduced, because sodium
competes with calcium for reabsorption
in the kidneys.
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• 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.
• Avoid intake of oxalate-containing foods
(eg,spinach,strawberries,rhubarb,tea,peanuts,
wheat bran).
PREVENTION
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• During the day, drink fluids (ideallywater)
every1 to 2 hours.
• Drink two glasses of water at bedtime
and an additional glass at each nighttime
awakening to prevent urine from
becoming too concentrated during the
night.
PREVENTION
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• Avoid activities leading to sudden
increases in environmental temperatures
that may cause excessive sweating and
dehydration.
• Contact your primary health care
provider at the first sign of a urinary
tract infection
PREVENTION
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QUESTIONS
???
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Thank you!!!