Renal calculi

Urolithiasis, nephrolithiasis, renal stone

 BEHRULAL
NAGAR
B.L. NAGAR
CONTENTS INTRODUCTION
DEFINITION
ETIOLOGY
TYPES OF RENAL CALCULI
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
DIAGNOSTICS EVALUATION
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT
DIETARY MANAGEMENT
NURSING MANAGEMENT
INTRODUCTION
•Urinary stone account for more than
320000 hospital admission each year.
•About the third to fifth decades of life
increase the risk of renal stones
•Renal affected man more than
womans.
DEFINITION

A disease condition marked

by the formation of the
stones in the urinary tract.
ETIOLOGY
• Immobility and sedentary lifestyle which increase the stasis.
• Dehydration
• Metabolic disturbance that result in an increase in calcium
or other ions in the urine.
• Previous history of renal calculi
• High mineral contain in the drinking water
• Prolong indwelling catheterization
• A diet high in purines, oxalates, calcium, supplement
animal protein
TYPES OF
R E N A L C A LC U L I

Calcium stone
Uric acid stone
Struvite stone
Cystine stone
PATHOPHYSIOLOGY
Hypercalciuria, hypercalcemia, urinary tract infection,
genetic defect in cysteine transport

Imbalance between degree of supersaturation of ions

forming the stones and the concentration of inhibitor in urine

Deposition of crystals, alkaline or acidity of urinary ph and low urinary volume

Renal stone formation

CLINICAL MENIFESTATION
• Pain
- in flank region
- pain in lower frank region (if stone is ureter)
Obstruction of urine
- decrease frequency of urine
- dysuria
- haematuria
Inflammatory symptoms
- fever
-chills
- diaphoresis
- abdominal discomfort
- nausea and vomiting
DIAGNOSTIC EVALUATION

•IVP ( intravenous pyelography)

•Retrograde ( pyelography)
•KUB X-ray
•Urine analysis for haematuria
COMPLICATION
•Infection
•Hydroureter
•Hydronephrosis
•Renal failure
MEDICAL MANAGEMENT
•There is no particular medication Use to treat
calcium stone
•If the client has uric acid such as
Allopurinol (zyloprin) should be given
Also narcotics and antispasmodic should be
given
SURGICAL MANAGEMENT
•The surgery perform may be a nephrolithotomy
(removal of stone by surgical incision) or a
nephrectomy (if the kidney is non functional)
•Stone in the kidney pelvis are removed by a
pyelolithotomy
•If the stone in ureter byureterolithotomy
DIETARY MANAGEMENT
• Increasing citric acid intake; lemon/lime juice is the richest natural source.[72]
• Moderate calcium intake
• Limiting sodium intake
• Avoidance of large doses of supplemental vitamin C
• Limiting animal protein intake men.
• Limiting consumption of cola soft drinks, which contain phosphoric acid, to less
than one liter of soft drink per week.
NURSING MANAGEMENT
• Diagnosis- acute pain related to inflammation obstruction of
the urinary tract
• Goal- pt. may include relief of pain and discomfort
• Intervention
-Opioid analgesics agents may be prescribed and
administered to provide rapid relief along with IV NSAID.
-The pt provide comfortable position.
The pain level monitor closely and in increase in severity
reported promptly to the physician so that relief can be
provided and additional treatment initiated
• Diagnosis- Impaired urinary elimination related to presence of calculi as
evidenced by haematuria
• Goal- as evidenced by urinary void of 4 times in the shift and
maintained the urinary output.
• Intervention-
• Assessed color, volume, odor and components of urine.
• Explain the need for 8-10 glasses of water consumption per day.
• Avoid drinking tea, and eating chocolates

• minimize also to eat foods rich in calcium such as cheese, milk, butter
• Diagnosis- Knowledge deficit related to information
of simultaneous medication that aggravated the present
kidney condition
• Goal- provide adequate knowledge about the treatment
• Intervention-
• Encourage the patient to tell to the attending physician
about the medication and treatment he is take in the
previous hospital
• Report the condition to the attending physician about his
history of treatment