Urinary Tract Calculi Flashcards
Urinary tract calculi
AKA nephrolithiasis
More common in men Average onset: 20-55 years Increased incidence: -white persons -family history of stone formation -previous history -summer months
When do we tend to see this?
During the warmer months and when hydration is an issue
Etiology and patho
Stone formation
No single etiology for all cases
Factors involved in stone formation
Metabolic Genetic Climate Lifestyle Occupational influences Obstruction with urinary stasis UTI
Mucoprotein forms the matrix and is affected by
Urinary pH
Solute load
Inhibitors in urine
The higher the pH…
calcium and phosphate are less soluble
alkaline
The lower the pH
uric acid and cysteine are less soluble
acidic
Calcium stones
From diet and dehydration Alkaline More common Calcium phosphate Calcium oxalate
Calcium oxalate stones
More common
caused by high calcium and high oxalate excretion
Calcium phosphate stones
caused by combination of high urine calcium and alkaline urine, meaning the urine has a high pH
Uric acid stones
High purine diet (fish/meats)
Acidic
Forms when urine is persistently acidic
Struvite stones
Magnesium ammonium phosphate
Result from kidney infections
Cystine stones
Result from genetic disorder that causes cystine to leak through kidneys and into urine, forming crystals that tend to accumulate into stones
Clinical manifestations
Sudden sever pain due to obstruction
Nausea and vomiting may accompany
Manifestations of UTI
Patients may be in mild shock with cool, moist skin
Common sites of obstructions
Ureteropelvic junction (UPJ) -Dull pain in costovertebral flank -Renal colic Ureterovesicular junction (UVJ) -abdomen (lower quadrant) -groin pain -testicular/labial pain
Renal colic
Term used for sharp, severe pain, which results from stretching, dilation, and spasm of ureter in response to obstructing stone
Pts have hard time sitting still
Diagnostic studies
Noncontrast spiral CT (CT/KUB) Ultrasonography Intravenous pyelorgraphy (IVP) Complete urinalysis including pH Retrieval and analysis of stones 24 hour urine analysis
Acute attacks
Treat pain (opioids) Infection Obstruction -tamsulosin -terazosin
Preventing further stone development
Pt and family history Geographic residence Nutritional assessment Activity patterns Immobilization or dehydration Surgery of GI or GU tract Drugs for prevention
Collaborative care
Drugs Endurologic procedure -cystoscopy, ureteroscopy Percutaneous nephrolithotomy Lithotripsy Surgical therapy -Nephrolithotomy -Pyelolithotomy -Ureterolithotomy -Cystotomy
Nutritional therapy
Adequate fluid intake Forcing fluids is contraindicated! Limit colas, coffee, tea Low-sodium diet Decrease dietary intake of substances causing the stone type
How much urine should you produce to ensure adequate fluid intake?
2 L of urine per day
Home management
Strain all urine
Self-monitor urinary pH
Lithotripsy
Shock/laser therapy to break stones
At what size can you let patient pass a stone?
<6mm
At what size do you go in and get stone out of patient?
> 6mm
