UROLITHIASISRENAL CALCULI

UROLITHIASIS

REFERS TO CALCIFICATIONS OR PRESENCE OF STONES IN

THE URINARY SYSTEM.NEPHROLITHIASIS- CALCULI

IN THE KIDNEY

ETIOLOGY• Men between 30 and 50 years old• Immobility and sedentary lifestyle which

increase stasis.• Dehydration, which leads to super

saturation• Metabolic isturbances resulting to increase

calcium and ions in the urine.• History of Urinary Calculi• Diet in high in Purine, Oxalates, Calcium• UTI• Prolonged indwelling catheterization

TYPES OF STONES• Calcium Stones

– Is the most common substances and is found in up to 90% of stones.

– Are usually composed of calcium phosphate or calcium oxalate.

– It caused by four main function:• A high rate of bone reabsorption.• Gut absorption of abnormally large amounts

of calcium, as in milk-alkali syndrome, sarcoidosis, and excessive intake of vitamin D

• Impaired renal tubular absorption of filtered calcium

• Structural abnormalities, such as “sponge kidney”

• Oxalate Stones– Second most frequent stone is oxalate, which

is relatively insoluble in urine.– Its solubility is affected only slightly by

changes in pH– Oxalate stones may be related to the following:

• Hyperabsorption of oxalate• Postileal resection or small bowel bypass

surgery• Overdose of ascorbic acid (vitamin C)• Familial oxaluria• Concurrent of fat malabsorption

• Struvite Stones– Also called “triple phosphate”– Composed of carbonate apatite and

magnesium ammonium phosphate– It cause by a certain bacteria, usually

Proteus, which contain enzyme ureas. This enzyme splits urea into two components ammonia molecule, which increase the urine pH (usually Alkaline). This ph is prone from bacteria.

– This stones formed in the manner are “STAGHORN CALCULI”

Anatomy

• Kidney, paired organ whose functions include removing waste products from the blood and regulating the amount of fluid in the body. The basic units of the kidneys are microscopically thin structures called nephrons, which filter the blood and cause wastes to be removed in the form of urine. Together with the bladder, two ureters, and the single urethra, the kidneys make up the body’s urinary system. Human beings, as well as members of all other vertebrate species, typically have

• A primary function of kidneys is the removal of poisonous wastes from the blood. Chief among these wastes are the nitrogen-containing compounds urea and uric acid, which result from the breakdown of proteins and nucleic acids. Life-threatening illnesses occur when too many of these waste products accumulate in the bloodstream. Fortunately, a healthy kidney can easily rid the body of these substances.

• In addition to cleaning the blood, the kidneys perform several other essential functions. One such activity is regulation of the amount of water contained in the blood. This process is influenced by antidiuretic hormone (ADH), also called vasopressin, which is produced in the hypothalamus (a part of the brain that regulates many internal functions) and stored in the nearby pituitary gland. Receptors in the brain monitor the blood’s water concentration. When the amount of salt and other substances in the blood becomes too high, the pituitary gland releases ADH into the bloodstream. When it enters the kidney, ADH makes the walls of the renal tubules and collecting ducts more permeable to water, so that more water is reabsorbed into the bloodstream.

PATHOPHYSIOLOGY•Crystals are formed from super

saturated urine with increase solutes.•Mucos and protiens bind to the mass of

stone forming matrix with lack of stone inhibtors. (citrate, Mg, pyrophospahate)

•Growth continues by aggregations to form larger particles travel down from urinary tract.

•Trapped and become site for stone formation

FORMATION OF STRUVITE STONES

Urea splitting bacteriaHydrolysisAmmoniaHydrolysis Struvite

stonesAmmonium hydroxideIncrease pH(alkaline)Increase amunt of deprotonated

phosphate

– Struvite stones is difficult to eliminate because of hard stone forms around a nucleus of the bacteria, which protecting the bacteria from antibiotic theraphy

– Any small fragment left after surgical removal of the stones begins the cycle again

• Uric Acid– Are caused by increased urate excretion fluid

depletion, and low urinary pH• Cystinuria

– Is the result of a congenital metabolic error as an autosomal recessive disorder

• Xanthine– Stones occur as a result of rare hereditary

condition in which there is a xanthine

SIGNS AND SYMPTOMS• Sharp excruciating severe pain of

sudden onset radiating from flank into the groin.

• Nausea and vomiting reflex action to pain

• Restlessness, diaphoresis, rapid pulse• Oliguria- obstruction made by stones• Hematuria- due to abrasive action of

stone as it moves doewn

Nursing ManagementFluids (3000 ml/day) unless contraindicated

• Strain all urine for passage of stone(80-90 of stones pass out spontaneously)

• Adjust urine ph• Ca stones• Limit dairy products• Acid ash diet ( cranberry/prune juice, meat, eggs, fish, poultry,

grapes, whole grain citrus fruits, • Vit. C• Oxalate stones• Avoid excess tea, chocolates, spinach • Acidic stones• Alkalinize urine

– Na Bicarbonate tablets– Alkaline - ash diet ( milk, vegetables, fruits, salmon)

• • Uric Acid stones

– Avoid purine foods

• Organ meat• Shellfish • Meat groups• Gravy• Legumes• Salted anchovies• Mushrooms• Sardines• ● Encourage ambulation• ● MIO – notify doctor for anuria or hematuria • ● Medication • Pain control ( Demerol)narcotic analgesic• Allopurinol (to ↓ uric acid)• ● Surgery ( Nephrolithotomy, pyelolithotomy,

uterolithotomy, litholapaxy)• ● ESWL ( extracorporeal shock wave lithotripsy)

crushing of stone with the use of ultrasonic waves while the body is half immersed in water.

Medical- Surgical Interventions• Endorologic Proceduures• 1.Small stones removed trans urethrally with a cystoscope,

ureteroscope, ureteroremoscope.• 2.Lithitrite- stone crusher instrument to facilitate removal of

stone.• 3. Lithotripsy• A. Laser Lithotripsy- lasers are used together with a

ureterooscope to remove or loosen impacted stones.• B. Extracorporeal Shockwave Lithotripsy- disintigration of

stone by use of laser release into the water producing shockwave.

• - place in special tank of water.• 4. Open Surgical Procedures• A. Ureterolithotomy- surgical removal of stones from the

ureter through flank incision for higher stones or abdominal incision for lower ones. Penrose drain is placed post op.

• B. Cystolithotomy- removal of bladder calculi through a supra pubic incision.

POSSIBLE NURSING DIAGNOSIS

• Acute pain related to irritation and spasm from stone movement in the urinary tract

• Risk for injury related to post operative complication

• Effective therapeutic regimen management related to prevention of calculi

•

Presented to:Mrs.Rosadel Faceronda

Evangelio, LalaaineGallofin, Arva Glazel

Gialolo, JennifeJubilan, Virgie Lyn

Labang, Kristine AnnLabrador, Josie Lou

Galaura, John May EmmanuelGallego, Mikhail