Nephrolithiasis Flashcards
Nephrolithiasis?
Kidney stones aka renal calculi (stones in urinary tract)
Is nephrolithiasis more common in men or women?
men
Etiology?
- increase precipitable components in the blood and urine
- structural changes in the urinary tract (eg. BPH)
- diet, fluid intake, rate of excretion, metabolic factors
- nucleus for stone formation
Defense mechanism of the kidneys?
Kidney produces proteins that inhibit crystallization of the components in urine
What happens if you have inadequate or defective proteins?
It will lead to crystallization
Patho?
Presence of stone inhibitors -> present in the urine and inhibit stones from forming. Increase concentration of solute and/or urine stasis results in precipitation of solute within the urine and likely formation of stones. The stone requires a tiny particle (nidus) and other precipitable components that gather around it to form the stone.
what are the stone inhibitors?
magnesium and citrate
Name for the tiny particle?
Nidus
Staghorn calculus?
referring to the shape and size of the stone
What are the types of stones?
- Calcium
- Magnesium Ammonium Phosphate
- Uric Acid
- Cystine
Manifestations?
- renal colick -> very severe pain
- intermittent pain
- ureter distention d/t migration
- non-colicky pain -> distention of renal pelvis and calyces
- Nausea and vomiting (d/t pain)
Diagnostics?
- pain presentation
- ultrasound/CT
- Urinalysis
- IVP
IVP?
Intravenous Pyelogram
Treatment?
- narcotics for pain relief asap
- antispasmodics (Buscopan) for colicky pain
- Antiemetics for N+V
- small stones (<5 mm) passed in urine
- treat the underlying cause (eg. BPH)
- larger stones may require surgery -> Lithotripsy
Lithotripsy?
use high frequency sound waves to blast the stones
