Urolithiasis.

BY: Santhosh Thomas,

Lecturer, YNC , 1/10/2018.
 Renal calculus or Urolithiasis

• Urolithiasis refers to stones (calculi) in the urinary

tract. Stones are formed in the urinary tract when

urinary concentrations of substances such as

calcium oxalate, calcium phosphate, and uric acid

increase.
 Types Of Stones in the urinary tract.

• Calcium stones

• Uric acid stones

• Struvite stones

• Cystine stones
 Etiology
 Certain factors favor the formation of stones, including
• Infection,
• Urinary stasis, and
• Periods of immobility (slows renal drainage and alters
calcium metabolism).
• Increased calcium concentrations in blood and urine
promote precipitation
• Causes of hypercalcemia (high serum calcium) and
hypercalciuria.
• Hyperparathyroidism
• Renal tubular acidosis
• Cancers
• Granulomatous diseases (sarcoidosis,
tuberculosis), which
may cause increased vitamin D production by
the granulomatous
tissue
• Excessive intake of vitamin D

• Excessive intake of milk and alkali

• Myeloproliferative diseases (leukemia, polycythemia

vera, multiple myeloma), which produce an unusual

proliferation of blood cells from the bone marrow

 Pathophysiology.
• Due to etiological factors

• Formation of stones in the urinary tract(Kidneys,

urinary bladder, ureters etc.)

• Obstruction to the urine flow.

• Increasing the hydrostatic pressure

• Clinical manifestations of disease.
 Clinical Manifestations.

• Excruciating Pain.

• Hematuria

• Vomiting and nausea

• Stones lodged in the ureter (ureteral obstruction) cause

acute, excruciating, colicky, wavelike pain, radiating down

the thigh and to the genitalia.

• The patient has a desire to void, but little urine

is passed, and it usually contains blood

because of the abrasive action of the stone.

This group of symptoms is called ureteral colic.

 Assessment and Diagnostic Findings.
• The diagnosis is confirmed by
• X-ray films of the kidneys, ureter, and bladder
(KUB)
• Ultrasonography,
• Intravenous urography, or
• Retrograde pyelography.
• Blood chemistries and a 24-hour urine test for
measurement of calcium, uric acid, creatinine,
sodium, pH, and total volume are part of the
diagnostic work
 COLLABORATIVE PROBLEMS/
POTENTIAL COMPLICATIONS

• Infection and sepsis (from UTI and

pyelonephritis)

• Obstruction of the urinary tract by a stone or

edema with subsequent acute renal failure

 Medical Management.

• The basic goals of management are to eradicate

the stone, to determine the stone type, to prevent

nephron destruction, to control infection, and to

relieve any obstruction that may be present.

• Opioid analgesics are administered to prevent

shock and syncope that may result from the

excruciating pain.

• NSAIDs may be as effective as other analgesics in

treating renal stone pain.

• Hot baths or moist heat to the flank areas may

also be useful.

• Fluids are encouraged. This increases the

hydrostatic pressure behind the stone.

• Unless contraindicated, any patient with renal

stones should drink at least eight 8-ounce

glasses of water daily to keep the urine dilute.

 Dietary Recommendations for Prevention
of Kidney Stones

• Restricting protein to 60 g/day is recommended to

decrease urinary excretion of calcium and uric
acid.
• A sodium restriction of 3–4 g/day is
recommended. Table salt and high-sodium foods
should be reduced because sodium competes with
calcium for reabsorption in the kidneys.
• Low-calcium diets are not generally recommended,
except for true absorptive hypercalciuria. Evidence
shows that limiting calcium, especially in women, can
lead to osteoporosis and does not prevent renal stones.

• Oxalate-containing foods (spinach, strawberries,

rhubarb, tea,peanuts, wheat bran) may be restricted.
 SURGICAL MANAGEMENT.

• If the stone is not passed spontaneously or if

complications occur, treatment modalities may include

surgical, endoscopic, or other procedures—for example,

ureteroscopy, extracorporeal shock wave lithotripsy

(ESWL), or endourologic (percutaneous) stone removal.

 Ureteroscopy.

• It involves first visualizing the stone and then

destroying it. Access to the stone is accomplished

by inserting a ureteroscope into the ureter and

then inserting a laser, electrohydraulic lithotriptor,

or ultrasound.
device through the ureteroscope to fragment

and remove the stones. A stent may be

inserted and left in place for 48 hours or more

after the procedure to keep the ureter patent.

 Extracorporeal
shock wave lithotripsy (ESWL)
• In this a high-energy amplitude of pressure, or shock wave,

is generated by the abrupt release of energy and

transmitted through water and soft tissues. When the

shock wave encounters a substance of different intensity (a

renal stone), a compression wave causes the surface of the

stone to fragment.
 Ultrasonic lithotriopsy.
• Uses high frequency sound waves delivered
through an electroic probe inserted into the
ureter to break up kidney stone.
 Electrohydraulic lithotripsy
• Uses a flexible probe to break up small stones
with shock waves generated by elctricity. The
probe is positioned close to the stone through
a flexible ureteroscope.
• Open Surgery to treat kidney stones.
• Percutaneous Nephrostolithotomy.
 Endourologic methods.

• Endourologic methods of stone removal may

be used to extract renal calculi that cannot be

removed by other procedures.

• A percutaneous nephrostomy or a percutaneous

nephrolithotomy (which are similar procedures) may be

performed, and a nephroscope is introduced through the

dilated percutaneous tract into the renal parenchyma.

Depending on its size, the stone may be extracted with

forceps.
 Nursing Diagnosis.

• Acute pain related to inflammation,

obstrucyion, and abrasion of the urinary tract

• Deficient knowledge regarding prevention of

recurrence of renal stones

 Nursing management.

• Assessment

• The patient with suspected renal stones is

assessed for pain and discomfort as well as

associated symptoms, such as nausea, vomiting,

diarrhea, and abdominal distention.

 Planning and Goals

• The major goals for the patient may include

relief of pain and discomfort, prevention of

recurrence of renal stones, and absence of

complications.
 Nursing Interventions.

• RELIEVING PAIN

• Immediate relief of the severe pain from renal or ureteral colic is

accomplished with the administration of opioid analgesic agents

(intravenous or intramuscular administration may be prescribed to

provide rapid relief) or NSAIDs

Teaching Patients Self-Care

• Because the risk of recurring renal stones is high, the

nurse provides education about the causes of kidney

stones and ways to prevent their recurrence . The

patient is encouraged to follow a regimen to avoid

further stone formation.

 Evaluation.

• Reports relief of pain

• States increased knowledge of health-seeking

behaviors to prevent recurrence.

• Experiences no complications.