KIDNEY STONE

Definition:

👉A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract.

 Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi.

Other related terms:

🔸 The condition of having kidney stones is termed nephrolithiasis. 

🔸Having stones at any location in the urinary tract is referred to as urolithiasis.

🔸The term ureterolithiasis is used to refer to stones located in the ureters.

CAUSES.

The cause of the problem depends on the type of stone.

✔The main cause of kidney Stones is when urine contains too much of certain substances that form crystals which in turn, can develop into stones over weeks or months.

RISK/PREDISPOSING FACTORS. 

 These include:

🌟Dehydration: Not drinking enough fluids can make pee become extra-concentrated(High urine specific gravity ). This increases the chance of crystals forming.

🌟An unhealthy diet and lifestyle: Drinking lots of sugary, caffeinated, or sports drinks and eating a diet high in sodium (salt) can increase the risk of calcium stones. Obesity also can make kids more likely to get them.

🌟Urinary tract defects: A structural defect in the urinary tract can block the flow of pee and create an area where it collects in a tiny pool. When pee stops flowing, crystal-forming substances may settle together and form stones.

🌟Some medicines: Some prescription and over-the-counter medicines can increase the risk of kidney stones if taken in large doses.

🌟Metabolic disorders: Having a metabolic disorder (a problem in the way the body breaks down and uses food) can lead to concentrated levels of oxalate (a substance made in the body and found in some foods) or cystine in the urine.

🌟Cystinuria: This genetic condition causes too much cystine to pass from the kidneys into the pee, causing cystine stones.

Other medical conditions: 

A number of diseases and conditions can increase the risk of kidney stones, including gout (a type of arthritis which causes abnormal metabolism of uric acid), other kidney diseases, conditions that affect the thyroid or parathyroid gland, and some urinary tract infections (UTIs),Immobility, Electrolyte imbalance (.e,g.hypercalcemia),Urinary stasis.

TYPES.

Nt:Knowing the type of kidney stone helps determine the cause and may give clues on how to reduce your risk of getting more kidney stones. Types of kidney stones include:

Calcium stones:

🏈Most common.

🏈Usually in the form of calcium oxalate. 

🏈Oxalate is a naturally occurring substance found in food. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels. 

🏈The liver also produces oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. 

🏈Calcium stones may also occur in the form of calcium phosphate.

Struvite stones: Struvite stones form in response to an infection, such as a urinary tract infection. 

🏈These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.

Uric acid stones: 

🏈Uric acid stones can form in people who don’t drink enough fluids or who lose too much fluid, those who eat a high-protein diet(excess purine),and those who have gout. 

🏈Certain genetic factors also may increase your risk of uric acid stones.

💃Cystine stones: 

🏈These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria). Having known the definition, causes&P.Fs, types....

PATHOPHYSIOLOGY.

👠Any of the listed causes (please,list them) will result in concentration of urine with insoluble materials.

👠Crystals from the materials, consolidate and form calculi that(made up of either calcium,uric acid,oxalate,cystine or struvite)

👠The calculi either remain in the renal pelvis and damage or destroy kidney tissues or they enter the urethra,obstructing urine flow thereby causing HYDRONEPHROSIS, OLIGURIA,INCREASED BLOOD UREA.

👠Irritation of the kidney tissues result in FLANK PAIN;and if there is an extent of kidney tissue damage..HEMATURIA,PYURIA,DYSURIA AND PYREXIA occur.

CLINICAL MANIFESTATIONS /SIGNS and SYMPTOMS 

😭Flank pain

😭Pyrexia (fever)

😭Dysuria 

😭Pyuria 

😭Hematuria 

😭Oliguria 

😭Elevated BUN

😭Acute,sharp intermittent pain (ureteric colic)

😭N&V

😭Abdominal distention.

😭Diarrhea.

 DIAGNOSTIC EVALUATION 

Note:✏Diagnosis starts with physical examination and review of medical history (Past and present).

Other diagnostic tests include:

👉Radiologic examination of the kidneys,ureters,and bladder (To reveal visible calculi,its location,size and shape).

👉Renal ultrasonography (reveals hydronephrosis)

👉Urinalysis(To show protein,WBC, pus,RBC in urine)due to renal tissue damage. 

👉Intravenous pyelography  (To determine size n location of calculi)

👉Serum Analysis (Detects mineral content of calculi;Calcium, phosphorus, uric acid,cystine,oxalate and struvite ).

MANAGEMENT. 

✏It is Based on the cause.

✏Goal:To minimize discomfort and prevent complications.

It is divided into 2 categories:

Pharmacologic Therapy 💊

💊Opioid. e.g. Morphine (To ease intense flank pain and ureteric colic)

💊Antiemetics.e.g.promethazine and scopolamine (to manage N&V)

💊Antibiotics.e.g. ciprofloxacin,nitrofurantoin (To treat and prevent infection )

💊Antispasmodics.e.g. Buscopan(to manage pain too )

💊Diuretics. e.g. frusemide (To prevent urinary stasis and further calculi)

💊Daily oral doses of ascorbic acid (To acidify the urine,calm nervous and muscular activities). 

💊 Calcium channel blockers and alpha-blockers: These relax your ureter, the tube through which pee passes from your kidney to your bladder. A wider ureter will help the stone move more quickly.

💊Potassium citrate or sodium citrate: If the stone is made from uric acid, one of these solutions might be given to dissolve it.

Surgical Therapy🔪✂

✂Extra-corporeal shock wave lithotripsy (To break up the calculi so that it can be passed out in urine).

✂Percutaneous Nephrolithotomy/pyelithotomy (Incision into the renal parenchyma to remove calculi)

✂Ureteroscopy (Insertion of instrument 2ru a cystoscope to remove or fragment the calculi)

✂Stone Dissolution  (Infusion of chemolytic solution to fragment or destroy d calculi)

✂Uretgerolithotomy (Removal of stones from the urethra)

✂Cystostomy (Opening into the bladder to evacuate stones)

Note:✏Urinary drainage can only be possible in the presence of hydronephrosis.

Our care is divided into 2:

Pre-operative (Admission phase)

Post operative  (Discharge)

 NURSING MGT.

🐵Admission:Provide comfort measures such as bed rest and encouraging/teaching relaxation techniques. 

🐵Physical care:Encourage ADLs .e.g.bath/routine change  of position if pt is immobile.

🌟Provide hot baths or moist heat to the flank areas.

🐵Nutrition /Fluid:Encourage copious fluid intake if pt ain't nauseated or vomiting,to increase urine production and passage of stones. 

Restrict or reduce dietary intake(according to d type of calculi present).e.g. For calcium stones>>Reduce dietary calcium,For uric acid stones>>Reduce purine/protein intake,For oxalate stones >>Avoid/reduce green leafy vegetables,beans,tea and coffee.

🐵Observation:Monitor input and output,signs of haemorrhage and sediments.

 🐵Post operative:Check surgical site for bleeding and manage accordingly. 

 🐵Education:Of pt and family on discharge including institution of measures to prevent recurrenceof calculi. e.g. increased fluid intake (3-4L/24hrs ),promote physical activity, monitor urine pH,encourage dietary modifications depending on the type or composition of calculi.

🌟Avoid activities leading to sudden increase in environmental T that may cause excessive sweating and dehydration(reduced urinary volume).

NRSG DIAGNOSES 

✏Acute pain rt inflammation, obstruction and injury to renal tissue eb ptverbalization of pain.

✏Hyperthermia rt alteration in T regulating centre in the hypothalamus due to inflammatory response/infection eb T reading of 38.0°C.

✏Deficient knowledge rt treatment regimen eb non-adherence to medications.

✏Risk for infection rt altered kidney function(injury to tissue).

COMPLICATIONS 

⚠UTI (Pyelonephritis)

⚠Obstruction of the Urinary Tract.

⚠Metabolic Acidosis 

⚠Decreased intestinal peristalsis.

⚠Urinary fistula

⚠Ureteral scarring and stenosis

⚠Ureteral perforation 

⚠Extravasation.

Prevention of Kidney stone

Some general precautions for a patient diagnosed with kidney stone disease are:

✏Increase your daily fluid intake (water intake should exceed two liters per day)-if you already have a renal failure you need to check with your doctor about how much water you can have.

✏Lower the content of animal protein in your diet (reduce meat intake)

✏Limit coffee, tea, and cola intake

✏Do not take the excess of Vitamin D supplements. Take them only as prescribed.

✏Lower daily salt intake (2000 mg sodium restriction per day)

✏Lemon and cranberry juice are considered safeLower intake of high oxalate content foods (example: spinach, beets, and chocolate)

✏Reduce your daily sugar intake.