RENAL PART 2 renal calculi

What condition is this?

● Urinary stone disease

● Nephrolithiasis

● Third most common urinary tract disorder

● Majority of stones develop in kidneys

● Crystalline that ranges from popcorn kernel shape to jagged starburst

● Causes urinary tract obstruction and pain

RENAL CALCULI

What are the 3 common site of obstruction in RENAL CALCULI?

● 3 common site of obstruction

○ Ureteropelvic junction

○ Where ureter crosses the iliac vessels

○ Ureterovesical junction

In RENAL CALCULI, what are the 4 basic types of stones?

Calcium (oxalate and phosphate)

Struvite

Uric Acid

Cystine

In RENAL CALCULI, what type of stone is this?

■ Most common (70-85%)

Calcium (oxalate and phosphate)

In RENAL CALCULI, what type of stone is this?

■ Related to recurrent bacterial UTI with organisms producing urease

○ Struvite

In RENAL CALCULI, what type of stone is this?

■ 5-10% of cases

■ Occurs as a result of increase level of urate in the blood and uric acid crystals in urine

■ Common in persons with gout

○ Uric Acid

In RENAL CALCULI, what type of stone is this?

■ Uncommon 1%

■ Caused by hereditary (cystinuria)

○ Cystine

ETIOLOGY & RISK FACTORS of RENAL CALCULI (FILL IN THE BLANKS):

• Disorders that leads to overexcretion and hypersaturation of calcium or oxalate

  • __

  • __

  • __

  • __

• Low quantities of citrate ( binds with Ca thereby acting as an inhibitor to stone formation)

• High uric acid levels

• Chronic dehydration

• Obesity

• Excess intake of supplemental calcium, sodium, protein

ETIOLOGY & RISK FACTORS of RENAL CALCULI (FILL IN THE BLANKS):

• Disorders that leads to overexcretion and hypersaturation of calcium or oxalate

  • Idiopathic hypercalciuria

  • Renal tubular acidosis

  • Primary hyperparathyroidism

  • Hyperoxaluria

• Low quantities of citrate ( binds with Ca thereby acting as an inhibitor to stone formation)

• High uric acid levels

• Chronic dehydration

• Obesity

• Excess intake of supplemental calcium, sodium, protein

PATHOGENESIS of RENAL CALCULI (FILL IN THE BLANKS):

• __

  • amount of dissolved crystals in the urine compared to the volume

• __

• Crystal __and —

• Cell/crystal __

• Crystals are able to stay dissolved in the urine until it becomes __

• With oversaturation, crystals come out of solution into solid and begins to grow around a particle

• Crystals grow at a rate depending on the saturation of urine

• Crystals aggregate and attaches to the __ and transported to the —

• FACTORS AFFECTING SATURATION

  • Water excretion

  • Amount of crystals

PATHOGENESIS of RENAL CALCULI (FILL IN THE BLANKS):

• Saturation

  • amount of dissolved crystals in the urine compared to the volume

• Nucleation

• Crystal growth and aggregation

• Cell/crystal interaction

• Crystals are able to stay dissolved in the urine until it becomes oversaturated

• With oversaturation, crystals come out of solution into solid and begins to grow around a particle

• Crystals grow at a rate depending on the saturation of urine

• Crystals aggregate and attaches to the urinary tract epithelium and transported to the cell membrane

• FACTORS AFFECTING SATURATION

  • Water excretion

  • Amount of crystals

What is the classic presentation of RENAL CALCULI?

Acute “colicky” flank pain radiating to groin or perineal areas

In the diagnosing RENAL CALCULI, what is the first line imaging test for renal colic?

Non-contrast helical CT scan

In treating RENAL CALCULI, if this is the size of the stones, it will pass spontaneously

<5mm

In treating RENAL CALCULI, this is used if the size of the stone is <1cm in proximal ureter.  It uses the transmission of shock waves to break the calculi into fragments. Its goal is to reduce the diameter to a point where for spontaneous passage

SHOCKWAVE LITHOTRIPSY

In treating RENAL CALCULI, this is used if the size of the stone is >1cm in proximal ureter. It involves a passing of scope through the urethra and bladder into the ureter until it is reached. Then a laser is passed through the scope producing photothermal lithotripsy

Ureteroscopy 

In treating RENAL CALCULI, if the stones are on the distal ureter, this is the most commonly used medical agent

TAMSULOSIN