urologic problems: nephrolithiasis Flashcards
what parts of the urinary system can become obstructed?
urethra
ureters
bladder
kidneys (renal pelvis)
renal pelvis
where urine is collected and drained to ureters
what factors determine how destructive an obstruction is?
degree
location (closer to kidneys = worse)
duration
timing
what causes destruction of the renal pelvis?
renal calculi (kidney stones)
what causes destruction of the ureter?
renal calculi (kidney stones)
pregnancy
tumors
what causes destruction of the bladder and urethra?
bladder cancer
neurogenic bladder
prostatic hyperplasia
prostate cancer
urethral strictures
complications of an obstruction
stasis of urine flow (increase risk for infection)
back-up pressure
-hydroureter (dilation of ureters)
-hydronephrosis (dilation of renal pelvis)
-postrenal acute kidney injury
manifestations of an acute obstruction depend on the…
site
cause
speed of onset
what factor determines the severity of pain?
SITE - is it large enough for blockage? is the blockage internal (stones)? external (prosthetic hyperplasia)? Onset fast or slow?
nephrolithiasis
renal calculi (kidney stones)
clumps of crystals in the urinary tract
where do kidney stones form?
renal pelvis and migrate through urinary tract and can get stuck in bladder, urethra, ureter
where are kidney stones located?
renal pelvis –> bladder –> urethra
risk factors for nephrolithiasis
sex (men)
20-30s
white
family hx
congenital defect
obesity
weather (hot)
how does weather affect nephrolithiasis?
hot weather –> increases risk for dehydration –> increases concentration –> increases formation of crystallized solutes clumping together
cause of nephrolithiasis
crystallized solutes in the urine
depends on:
-individual risk factors
-characteristics of the urine (diet, medications)
-type of stone being formed
types of kidney stones
calcium oxalate
struvite (“staghorn”)
uric acid
calcium oxalate: incidence and specific risks
75%
-extreme pain
risks:
family hx
idiopathic
increase calcemia (Ca in blood)
increase oxaluria (oxalate in blood)
struvite (“staghorn”): incidence and specific risks
staghorn: stay in renal pelvis
-can become very large
-no pain
-surgically removed
7-10%
risks:
UTI
(caused by bacteria breaking down products in urine)
uric acid: incidence and specific risks
7-10%
risks: gout
patho of nephrolitiasis
urine is a solution of solvent (water) and solutes (particles)
problem: super saturation with a solute
crystals begin forming in the nephron
what increases the risk of nephrolithiasis?
dehydration
immobility/sedentary lifestyle
clinical manifestations of acute renal colic
located in flank
radiates down along groin
spasms
intermittent, sharp pain
-N/V
-diaphoresis
-increase HR
-increase RR
*lower UTI symptoms (dysuria, hematuria, etc.)
nephrolithiasis treatment for acute pain
morphine
NSAIDS
IV fluids (keep urine diluted + moving to push stones through)
preventive meds for calcium oxalate
thiazide diuretics
preventive meds for struvite
antibiotics
preventive meds for urate/uric acid stones
allopurinol
